title: Quality of reporting and evidence in American Academy of Pediatrics guidelines.
abstract: OBJECTIVE
  The primary objectives were to evaluate the quality of development and reporting of American Academy of Pediatrics (AAP) guidelines and to determine the level of evidence underlying the recommendations.
  
  
  METHODS
  Two reviewers scored each guideline by using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) instrument and determined the level of evidence for each recommendation in each guideline. Subgroup analyses compared AAP guidelines published before and after key changes in AAP guideline development policy and compared internal with endorsed guidelines.
  
  
  RESULTS
  For the 28 current guidelines, the highest average scores on AGREE-II were in scope and purpose (75%) and clarity of presentation (73%). The lowest average scores were in editorial independence (17%) and applicability (30%). The only domain that improved after AAP policy updates was editorial independence (P = .01). Of the 190 treatment recommendations, 43% were based on experimental studies, 30% on observational studies, and 27% on expert opinion or no reference. Compared with early guidelines, late guidelines included a higher proportion of treatment recommendations based on experimental studies (P = .05).
  
  
  CONCLUSIONS
  There was no clear improvement in the quality of development and reporting of AAP clinical practice guidelines over time. Routine application of AGREE-II to guideline development could enhance guideline quality. The proportion of guideline recommendations based on experimental evidence has increased slightly over time. Pediatric research agendas should be matched to vital gaps in the evidence underlying pediatric guidelines.
authors.affiliation: Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andre
authors.initials: A
authors.lastname: Isaac
authors.forename: Michael
authors.initials: M
authors.lastname: Saginur
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.forename: Joan L
authors.initials: JL
authors.lastname: Robinson
mesh_terms: D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D015588:Observer Variation; D016134:Organizational Policy; D010372:Pediatrics; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical; D014481:United States