title: Methodological quality of national guidelines for pediatric inpatient conditions.
abstract: BACKGROUND
  Guidelines help inform standardization of care for quality improvement (QI). The Pediatric Research in Inpatient Settings network published a prioritization list of inpatient conditions with high prevalence, cost, and variation in resource utilization across children's hospitals. The methodological quality of guidelines for priority conditions is unknown.
  
  
  OBJECTIVE
  To rate the methodological quality of national guidelines for 20 priority pediatric inpatient conditions.
  
  
  METHODS
  We searched sources including PubMed for national guidelines published from 2002 to 2012. Guidelines specific to 1 organism, test or treatment, or institution were excluded. Guidelines were rated by 2 raters using a validated tool (Appraisal of Guidelines for Research and Evaluation) with an overall rating on a 7-point scale (7 = the highest). Inter-rater reliability was measured with a weighted kappa coefficient.
  
  
  RESULTS
  Seventeen guidelines met inclusion criteria for 13 conditions; 7 conditions yielded no relevant national guidelines. The highest methodological-quality guidelines were for asthma, tonsillectomy, and bronchiolitis (mean overall rating 7, 6.5, and 6.5, respectively); the lowest were for sickle cell disease (2 guidelines) and dental caries (mean overall rating 4, 3.5, and 3, respectively). The overall weighted kappa was 0.83 (95% confidence interval 0.78-0.87).
  
  
  CONCLUSIONS
  We identified a group of moderate to high methodological-quality national guidelines for priority pediatric inpatient conditions. Hospitals should consider these guidelines to inform QI initiatives.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Hester
authors.forename: Katherine
authors.initials: K
authors.lastname: Nelson
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.forename: Emily
authors.initials: E
authors.lastname: Eresuma
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014481:United States