title: The quality of guidelines in pediatric surgery: can we all AGREE?
abstract: OBJECTIVE
  Guidelines are meant to facilitate evidence-based clinical decision-making but vary in methodological rigor and quality of reporting. We assessed the quality of guidelines published in major pediatric surgery journals.
  
  
  METHODS
  A MEDLINE search of 4 key pediatric surgery journals was performed. Included studies had guidelines, clinical practice guidelines, and consensus statements as a subject heading or keyword. Evaluations of guidelines were excluded. Eligible guidelines were assessed by three reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument.
  
  
  RESULTS
  Our search identified ten guidelines for review. Agreement for study selection was excellent [K = 0.81 (95 % CI 0.63-0.99)]. The mean AGREE II score for individual guidelines was 18 % (SD 5.7 %). The best-scored quality domains were "scope and purpose" [mean score 49 % (SD 8.7 %)] and "clarity of presentation" [mean score 40 % (SD 18.7 %)]. The poorest score was for "editorial independence" [mean score 2 % (SD 3.7 %)].
  
  
  CONCLUSIONS
  The overall quality of guidelines in pediatric surgery, using AGREE II, is poor and may lead to inappropriate clinical decisions. Increased awareness of proper reporting and the methodological requirements for guideline development are needed to optimize the potential of guideline recommendations to improve practice.
  
  
  METHODS
  n/a (Quality Appraisal).
authors.affiliation: Department of Pediatric Surgery, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada, annashawyer@gmail.com.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Shawyer
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.forename: Veena
authors.initials: V
authors.lastname: Manja
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D013514:Surgical Procedures, Operative / Q000592:standards*