title: Clinical guidelines in pediatric headache: evaluation of quality using the AGREE II instrument.
abstract: BACKGROUND
  The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool is a validated questionnaire used to assess the methodological quality of clinical guidelines (CGs). We used the AGREE II tool to assess the development process, the methodological quality, and the quality of reporting of available pediatric CGs for the management of headache in children. We also studied the variability in responses related to the characteristics of eleven Italian neuropediatric centers, showing similarities and differences in the main recommendations reported in CGs.
  
  
  METHODS
  A systematic literature search was conducted from January 2002 to June 2013 on Mediline, the Cochrane database, the National Guideline Clearinghouse website and the NHS evidence search tool, using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs providing information on the diagnosis and management of headache and specific recommendations for children were selected. Eleven neuropediatric centers assessed the overall quality and the appropriateness of all available CGs using of the AGREE II instrument.
  
  
  RESULTS
  Six CGs meeting the inclusion and exclusion criteria were identified and assessed by 11 reviewers. Our study showed that the NICE CGs was "strongly recommended" while the French and Danish CGs were mainly "not recommended". The comparison between the overall quality score of the French CGs and the NICE CGs was statistically significant (6.54 ± 0.69 vs. 4.18 ± 1.08; p =0.001). The correlation analysis between quality domain score and guideline publication date showed a statistically significant association only for the "editorial independence" domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the 11 reviewers had the highest agreement for the Lewis CGs (r = 0.857), and the lowest one for the NICE CGs (r = 0.656). Statistical analyses showed that professionals from outpatient services dedicated pediatric headache assigned a higher overall quality score to the NICE CGs as compared to professionals from non-outpatient services (6.86 ± 0.38 vs. 6.0 ± 0.82; p = 0.038).
  
  
  CONCLUSIONS
  CGs resulted definitely of low-moderate quality and non "homogeneous". Further major efforts are needed to update the existing CGs according to the principles of evidence based medicine.
authors.affiliation: NESMOS Department, Chair of Paediatrics, Pediatric Headache Centre, Paediatric Sleep, Centre & Child Neurology, Faculty of Medicine & Psychology, "Sapienza University" c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039 Rome, Italy. pasquale.parisi@uniroma1.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Parisi
authors.forename: Nicola
authors.initials: N
authors.lastname: Vanacore
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Belcastro
authors.forename: Marco
authors.initials: M
authors.lastname: Carotenuto
authors.forename: Ennio
authors.initials: E
authors.lastname: Del Giudice
authors.forename: Rosanna
authors.initials: R
authors.lastname: Mariani
authors.forename: Laura
authors.initials: L
authors.lastname: Papetti
authors.forename: Piero
authors.initials: P
authors.lastname: Pavone
authors.forename: Salvatore
authors.initials: S
authors.lastname: Savasta
authors.forename: Pasquale
authors.initials: P
authors.lastname: Striano
authors.forename: Irene
authors.initials: I
authors.lastname: Toldo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tozzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.forename: Umberto
authors.initials: U
authors.lastname: Raucci
mesh_terms: D002648:Child; D019317:Evidence-Based Medicine / Q000592:standards*; D006261:Headache / Q000628:therapy*; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D013222:State Medicine