CoDAS
https://codas.org.br/article/doi/10.1590/2317-1782/e20240016en
CoDAS
Artigo Original

Quality assessment of clinical guidelines in the care of laryngitis and pharyngitis according to AGREE II

Lucas Mateus Rodrigues Carvalho; Ana Paula de Oliveira Barbosa; Nara Amanda Laismann; Débora Santos Lula Barros; Rodrigo Fonseca Lima; Rafael Santos Santana

Downloads: 0
Views: 89

Abstract

ABSTRACT: Purpose: The study aimed to identify and assess the methodological quality of essential clinical guidelines for the management of laryngitis and pharyngitis.

Methods: A systematic search of clinical guidelines for the management of laryngitis and pharyngitis was performed in three databases. Methodological quality was assessed according to AGREE II, in which each item in its domains was scored by four independent evaluators. To determine the agreement, a weighted Kappa square statistic calculation was performed.

Results: 81 studies were found in the bibliographic sources consulted and all were evaluated. Considering the exclusion criteria, seven guidelines were selected for final evaluation by AGREE II. The squared weighted Kappa coefficient calculated after the first round of evaluation by AGREE II was 0.85, within an almost perfect agreement rate. The domains “stakeholder engagement”, “applicability”, and “editorial independence” had the lowest mean scores and the highest standard deviation indices. They had, respectively, a mean score of (63.7%) with a standard deviation of (17%), a mean score of (65.7%) with a standard deviation of (22%), and a mean score of (35%) with a standard deviation of (23%). The use of penicillin, erythromycin, ampicillin, amoxicillin, azithromycin and clarithromycin were recommended in (75%) of all guidelines that presented pharmacological measures. As a non-pharmacological measure, oral rehydration and gargling were recommended by two guidelines.

Conclusion: The statistical results indicate that all guidelines were considered as recommended. However, no uniformity was observed in the recommendations of these seven guidelines with regard to non-pharmacological and pharmacological treatment.

Keywords

Laryngitis, Pharyngitis, AGREE II, Evidence-based Practice, Pharmaceutical Services, Practice Guideline

Referências

1 Ada Health GmbH. Acute pharyngitis: symptoms: viral: bacterial [Internet]. 2022 [cited 2023 July 17]. Available from: https://ada.com/pt/conditions/acute-pharyngitis/

2 Donowitz JR. Acute pharyngitis: symptoms, diagnosis and treatment [Internet]. BMJ Best Practice; 2023 [cited 2023 July 17]. Available from: https://bestpractice.bmj.com/topics/en-gb/5

3 ABORL CCF: Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Guideline IVAS: infecções das vias aéreas superiores. São Paulo: Wolters Kluwer Health; 2019.

4 Whited CW, Dailey SH. Laryngitis: symptoms, diagnosis and treatment [Internet]. BMJ Best Practice; 2023 [cited 2023 July 17]. Available from: https://bestpractice.bmj.com/topics/en-gb/423

5 Donowitz JR. Acute pharyngitis: epidemiology [Internet]. BMJ Best Practice; 2023 [cited 2023 July 17]. Available from: https://bestpractice.bmj.com/topics/pt-br/5/epidemiology

6 Galvao CM, Sawada NO, Rossi LA. Evidence-based practice: theoretical considerations for its implementation in perioperative nursing. Rev Lat Am Enfermagem. 2002;10(5):690-5. PMid:12641056.

7 Brasil. Ministério da Saúde. Methodological guidelines: elaborating clinical [Internet]. 2016 [cited 2023 July 17]. Available from: https://pesquisa.bvsalud.org/bvsms/resource/pt/mis-37636

8 Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? JAMA. 1999;281(20):1900-5. http://doi.org/10.1001/jama.281.20.1900. PMid:10349893.

9 Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet. 2017;390(10092):415-23. http://doi.org/10.1016/S0140-6736(16)31592-6. PMid:28215660.

10 São Paulo. Governo do Estado. Instituto de Saúde. Saúde Baseada em Evidências (SBE) [Internet]. 2022 [cited 2023 July 17]. Available from: https://www.saude.sp.gov.br/instituto-de-saude/estrutura/nucleos/avaliacao-de-tecnologias-em-saude-ats/saude-baseada-em-evidencias-sbe

11 AGREE Enterprise. Advancing the science of practice guidelines [Internet]. 2013 [cited 2023 July 17]. Available from: https://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf

12 Costa AP, Reis TM, Santana RS. Elaboração de diretriz clínica para o cuidado farmacêutico na febre. Int J Dev Res. 2022;12:54550-3.

13 Lima BFR, Alves BMCS, Tavares NUL, Lima RF, Ginani VC, Reis TM, et al. Quality appraisal of clinical guidelines for the management of constipation according to AGREE II instrument. Res Soc Dev. 2022;11(3):e57911327086.

14 Costa AP, Alves BMCS, Silva DLM, Martins RLM, Silva FA, Zimmermann IR, et al. Diretrizes clínicas para cessação do tabagismo: análise comparativa com o AGREE II. Brasília Med. 2022;59:1-11.

15 Vaz JM, Alves BM, Duarte DB, Marques LA, Santana RS. Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method. Cephalalgia. 2022;42(3):239-49. http://doi.org/10.1177/03331024211037297. PMid:34404264.

16 Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839-42. http://doi.org/10.1503/cmaj.090449. PMid:20603348.

17 Latorraca CD, Pacheco RL, Martimbianco AL, Pachito DV, Riera R. AGREE II: a tool to assess the quality and reporting of guidelines: descriptive study. Diagn Treat. 2018;23(4):141-6.

18 Hoffmann-Eßer W, Siering U, Neugebauer EAM, Brockhaus AC, Lampert U, Eikermann M. Guideline appraisal with AGREE II: systematic review of the current evidence on how users handle the 2 overall assessments. PLoS One. 2017;12(3):e0174831. http://doi.org/10.1371/journal.pone.0174831. PMid:28358870.

19 Anwer MA, Al‐Fahed OB, Arif SI, Amer YS, Titi MA, Al‐Rukban MO. Quality assessment of recent evidence‐based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument. J Eval Clin Pract. 2018;24(1):166-72. http://doi.org/10.1111/jep.12785. PMid:28948654.

20 Santana RS, de Oliveira Lupatini E, Zanghelini F, de March Ronsoni R, Rech N, Leite SN. The different clinical guideline standards in Brazil: high cost treatment diseases versus poverty-related diseases. PLoS One. 2018;13(10):e0204723. http://doi.org/10.1371/journal.pone.0204723. PMid:30332422.

21 Kraemer HC. Kappa coefficient. New York: Wiley; 2015. http://doi.org/10.1002/9781118445112.stat00365.pub2

22 Chiappini E, Bortone B, Di Mauro G, Esposito S, Galli L, Landi M, et al. Choosing wisely: the top-5 recommendations from the Italian panel of the national guidelines for the management of acute pharyngitis in children. Clin Ther. 2017;39(3):646-9. http://doi.org/10.1016/j.clinthera.2017.01.021. PMid:28185714.

23 Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Executive summary: clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America. Clin Infect Dis. 2012;55(10):1279-82. http://doi.org/10.1093/cid/cis847. PMid:23091044.

24 Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, et al. Clinical practice guideline: hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg. 2018;158(S1):S1-42. http://doi.org/10.1177/0194599817751030. PMid:29494321.

25 Tapiainen T, Aittoniemi J, Immonen J, Jylkkä H, Meinander T, Nuolivirta K, et al. Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatr. 2016;105(1):44-9. http://doi.org/10.1111/apa.13162. PMid:26295564.

26 Chiappini E, Mazzantini R, Bruzzese E, Capuano A, Colombo M, Cricelli C, et al. Rational use of antibiotics for the management of children’s respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics. Paediatr Respir Rev. 2014;15(3):231-6. http://doi.org/10.1016/j.prrv.2013.11.011. PMid:24666567.

27 Francis DO, Smith LJ. Hoarseness guidelines redux: toward improved treatment of patients with dysphonia. Otolaryngol Clin North Am. 2019;52(4):597-605. http://doi.org/10.1016/j.otc.2019.03.003. PMid:31101359.

28 National Institute for Health and Care Excellence. Sore throat (acute): antimicrobial prescribing [Internet]. 2018 [cited 2023 July 17]. Available from: https://www.nice.org.uk/guidance/ng84

29 Alonso-Coello P, Irfan A, Sola I, Gich I, Delgado-Noguera M, Rigau D, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care. 2010;19(6):e58-58. http://doi.org/10.1136/qshc.2010.042077. PMid:21127089.

30 Hoffmann-Eßer W, Siering U, Neugebauer EAM, Lampert U, Eikermann M. Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument: a third of AGREE II users apply a cut-off for guideline quality. J Clin Epidemiol. 2018;95:120-7. http://doi.org/10.1016/j.jclinepi.2017.12.009. PMid:29288133.

31 Krüger K, Töpfner N, Berner R, Windfuhr J, Oltrogge JH. Sore Throat. Dtsch Arztebl Int. 2021;118(11):188-94. http://doi.org/10.3238/arztebl.m2021.0121. PMid:33602392.

32 Cots JM, Alós JI, Bárcena M, Boleda X, Cañada JL, Gómez N, et al. Recomendaciones para el manejo de la faringoamigdalitis aguda del adulto. Acta Otorrinolaringol Esp. 2015;66(3):159-70. http://doi.org/10.1016/j.otorri.2015.01.001. PMid:25772389.

33 Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349(21):g5827-5827. http://doi.org/10.1136/bmj.g5827 PMid:25300640.

34 Costa AP, Alves BMCS, Silva DLM, Melo Martins RL, Silva FA, Zimmermann IR, et al. Diretrizes clínicas para cessação do tabagismo: análise comparativa com o agree II. Brasília Med. 2022;59:1-11. http://doi.org/10.5935/2236-5117.2022v59a285

35 Llor C, Cots JM. Certezas y dudas sobre el manejo de la faringitis aguda. Aten Primaria. 2015;47(4):193-4. http://doi.org/10.1016/j.aprim.2015.01.008. PMid:25835134.

36 Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2015;2015(5):CD004783. http://doi.org/10.1002/14651858.CD004783.pub5. PMid:26002823.

37 Chiappini E, Bortone B, Di Mauro G, Esposito S, Galli L, Landi M, et al. Choosing Wisely: the Top-5 recommendations from the italian panel of the national guidelines for the management of acute pharyngitis in children. Clin Ther. 2017;39(3):646-9. http://doi.org/10.1016/j.clinthera.2017.01.021. PMid:28185714.

38 Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-102. http://doi.org/10.1093/cid/cis629. PMid:22965026.

39 Robinson JL. Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance. Drugs Context. 2021;10:1-12. http://doi.org/10.7573/dic.2020-11-6. PMid:33828608.

40 Chiappini E, Regoli M, Bonsignori F, Sollai S, Parretti A, Galli L, et al. Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther. 2011;33(1):48-58. http://doi.org/10.1016/j.clinthera.2011.02.001. PMid:21397773.

41 Chorath K, Prasad A, Luu N, Go B, Moreira A, Rajasekaran K. Critical review of clinical practice guidelines for evaluation of neck mass in adults. Rev Bras Otorrinolaringol (Engl Ed). 2022;88(4):625-32. http://doi.org/10.1016/j.bjorl.2021.03.005. PMid:33879419.

42 Rohde A, Worrall L, Le Dorze G. Systematic review of the quality of clinical guidelines for aphasia in stroke management. J Eval Clin Pract. 2013;19(6):994-1003. http://doi.org/10.1111/jep.12023. PMid:23448162.

43 Vaz JM, Alves BM, Duarte DB, Marques LA, Santana RS. Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method. Cephalalgia. 2022;42(3):239-49. http://doi.org/10.1177/03331024211037297. PMid:34404264.

44 Matthys J, De Meyere M, van Driel ML, De Sutter A. Differences among international pharyngitis guidelines: not just academic. Ann Fam Med. 2007;5(5):436-43. http://doi.org/10.1370/afm.741. PMid:17893386.

45 Brasil. Ministério da Saúde. Diretrizes metodológicas: elaboração de diretrizes clínicas. Brasília: Ministério da Saúde; 2023. 138 p.

46 Santos AO, Barros FPC, Delduque MC. A pesquisa em saúde no Brasil: desafios a enfrentar. Saúde Debate. 2019;43(spe5):126-36. http://doi.org/10.1590/0103-11042019s511.
 


Submetido em:
22/01/2024

Aceito em:
06/06/2024

67be39aaa953950a753126e5 codas Articles

CoDAS

Share this page
Page Sections