Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202200321
Jornal Vascular Brasileiro
Review Article

Qualidade metodológica das diretrizes de tratamento da doença arterial obstrutiva carotídea: uma avaliação sistemática com a utilização do instrumento AGREE II

The quality of guidelines for treatment of carotid artery disease: a critical appraisal using the AGREE II instrument

Stefany Gimenes Baptista Coutinho; Joelma Cavalcante Ricardo; Alexandre Inacio Moreira Coutinho; Leonardo Pessoa Cavalcante

Downloads: 3
Views: 21

Resumo

Resumo: Diretrizes clínicas (DCs) são recomendações estruturadas baseadas na revisão sistemática da evidência disponível, sendo ferramentas úteis na tomada de decisões clínicas. Entretanto, estudos têm levantado preocupação quanto à qualidade metodológica e científica de várias DCs, que podem afetar sua aplicação na prática clínica. O objetivo do presente estudo foi fazer uma avaliação sistemática da qualidade metodológica das DCs que abordam o tratamento da doença arterial obstrutiva carotídea, publicadas entre 2000 e 2019, utilizando a ferramenta AGREE II (Appraisal of Guidelines Research and Evaluation Instrument II). Os pesquisadores avaliaram independentemente a qualidade das DCs incluídas no estudo em cada um dos seis domínios da ferramenta AGREE II. Por meio de um sistema de pontuação, as DCs foram classificadas em alta, moderada e baixa qualidade. Um total de nove DCs foram selecionadas. Exceto pelo domínio dois (Kappa = 0,715), houve concordância excelente entre os três avaliadores (Kappa > 0,75). Considerando-se a avaliação global da qualidade metodológica das DCs, cinco foram consideradas de alta qualidade (55%), duas foram consideradas de qualidade moderada e duas foram consideradas de baixa qualidade. Concluímos que (1) foi factível a utilização da AGREE II para a avaliação de DCs sobre o tratamento da doença arterial obstrutiva carotídea com alto grau de concordância inter-avaliadores; e que (2) a maioria das DCs disponíveis sobre o tratamento da doença arterial obstrutiva carotídea tem alta qualidade metodológica.

Palavras-chave

guia de prática clínica, doenças das artérias carótidas, aterosclerose, estenose das carótidas

Abstract

Clinical Practice Guidelines (CPG) are structured recommendations based on systematic reviews of the available evidence and are useful tools to support clinical decision-making. However, studies have raised concerns about the methodological and scientific quality of several CPG, which can affect their application in clinical practice. The objective of this study was to perform a systematic appraisal of the methodological quality of carotid atherosclerotic disease clinical guidelines, published from 2000 to 2019, using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation Instrument II). The appraisers independently assessed the quality of the CPG included in the study for each of the 6 domains of the AGREE II tool. The CPG were rated as high, moderate, or low quality using a points scale. A total of 9 CPGs were selected for appraisal. Except for domain 2 (kappa=0.715), excellent agreement was observed between the appraisers (kappa>0.75). Five of the CPGs were rated as high overall methodological quality rating, 5 were rated as moderate overall methodological quality, and 2 were rated low overall methodological quality. The authors conclude that: (1) appraisal of carotid atherosclerotic disease clinical guidelines using the AGREE II instrument is feasible, with a high degree of agreement among appraisers; and (2) that most CPGs on the management of atherosclerotic carotid disease have high methodological quality.

Keywords

practice guideline; carotid artery diseases; atherosclerosis; carotid stenosis

References

1 Field MJ, Lohr KN. Clinical practice guidelines: directions for a new program. Washington: National Academies Press; 1990. [citado 2022 maio 10]. https://nap.nationalacademies.org/catalog/1626/clinical-practice-guidelines-directions-for-a-new-program.

2 Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E. Clinical practice guidelines we can trust. Washington: National Academies Press; 2011. http://dx.doi.org/10.17226/13058.

3 Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527-30. http://dx.doi.org/10.1136/bmj.318.7182.527. PMid:10024268.

4 Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001;39(8):II46-54. http://dx.doi.org/10.1097/00005650-200108002-00003. PMid:11583121.

5 Reis ECD, Passos SRL, Santos MABD. Quality assessment of clinical guidelines for the treatment of obesity in adults: application of the AGREE II instrument. Cad Saúde Pública. 2018;34(6):e00050517. http://dx.doi.org/10.1590/0102-311x00050517. PMid:29952398.

6 Al-Ansary LA, Tricco AC, Adi Y, et al. A systematic review of recent clinical practice guidelines on the diagnosis, assessment and management of hypertension. PLoS One. 2013;8(1):e53744. http://dx.doi.org/10.1371/journal.pone.0053744. PMid:23349738.

7 Kung J, Miller RR, Mackowiak PA. Failure of clinical practice guidelines to meet institute of medicine standards: two more decades of little, if any, progress. Arch Intern Med. 2012;172(21):1628-33. http://dx.doi.org/10.1001/2013.jamainternmed.56. PMid:23089902.

8 Vlayen J, Aertgeerts B, Hannes K, Sermeus W, Ramaekers D. A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care. 2005;17(3):235-42. http://dx.doi.org/10.1093/intqhc/mzi027. PMid:15743883.

9 Siering U, Eikermann M, Hausner E, Hoffmann-Eßer W, Neugebauer EA. Appraisal tools for clinical practice guidelines: a systematic review. PLoS One. 2013;8(12):e82915. http://dx.doi.org/10.1371/journal.pone.0082915. PMid:24349397.

10 AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12(1):18-23. http://dx.doi.org/10.1136/qhc.12.1.18. PMid:12571340.

11 AGREE Next Steps Consortium [site na Internet]. Ottawa: Canadian Institutes of Health Research; 2009. [citado 2022 jan 02]. http://www.agreetrust.org.

12 Alonso-Coello P, Irfan A, Solà I, 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. PMid:21127089.

13 Legido-Quigley H, Panteli D, Brusamento S, et al. Clinical guidelines in the European Union: mapping the regulatory basis, development, quality control, implementation and evaluation across member states. Health Policy. 2012;107(2-3):146-56. http://dx.doi.org/10.1016/j.healthpol.2012.08.004. PMid:22939646.

14 Khan GS, Stein AT. Adaptação transcultural do instrumento Appraisal of Guidelines for Research & Evaluation II (AGREE II) para avaliação de diretrizes clínicas. Cad Saúde Pública. 2014;30(5):1111-4. http://dx.doi.org/10.1590/0102-311X00174912. PMid:24936826.

15 Ronsoni RM, Pereira CC, Stein AT, Osanai MH, Machado CJ. Avaliação de oito Protocolos Clínicos e Diretrizes Terapêuticas (PCDT) do Ministério da Saúde por meio do instrumento AGREE II: um estudo piloto. Cad Saúde Pública. 2015;31(6):1157-62. http://dx.doi.org/10.1590/0102-311X00118814. PMid:26200364.

16 Molino CG, Romano-Lieber NS, Ribeiro E, Melo DO. Non-communicable disease clinical practice guidelines in Brazil: a systematic assessment of methodological quality and transparency. PLoS One. 2016;11(11):e0166367. http://dx.doi.org/10.1371/journal.pone.0166367. PMid:27846245.

17 Cotrim HP, Parise ER, Figueiredo-Mendes C, Galizzi-Filho J, Porta G, Oliveira CP. Nonalcoholic fatty liver disease Brazilian Society of Hepatology Consensus. Arq Gastroenterol. 2016;53(2):118-22. http://dx.doi.org/10.1590/S0004-28032016000200013. PMid:27305420.

18 Westphal GA, Garcia VD, Souza RL, et al. Guidelines for the assessment and acceptance of potential brain-dead organ donors. Rev Bras Ter Intensiva. 2016;28(3):220-55. http://dx.doi.org/10.5935/0103-507X.20160049. PMid:27737418.

19 Abbott AL. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke. 2009;40(10):e573-83. http://dx.doi.org/10.1161/STROKEAHA.109.556068. PMid:19696421.

20 Sitrângulo CJ, Silva ES. Carotid atherosclerotic disease. J Vasc Bras. 2018;17(3):179-83. PMid:30643502.

21 Fleiss JL, Levin B, Paik MC. Statistical method for rates and proportions. 3a ed. Hoboken: John Wiley & Sons; 2003. The measurement of interrater agreement, p. 598-626. http://dx.doi.org/10.1002/0471445428.ch18.

22 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74. http://dx.doi.org/10.2307/2529310. PMid:843571.

23 Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO) the Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816. http://dx.doi.org/10.1093/eurheartj/ehx095. PMid:28886620.

24 Naylor AR, Ricco JB, Borst GJ, et al. Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3-81. http://dx.doi.org/10.1016/j.ejvs.2017.06.021. PMid:28851594.

25 Presti C, Miranda FM Jr, Silva JCCB, et al. Doença carotídea extracraniana - diagnóstico e tratamento. São Paulo: Sociedade Brasileira de Angiologia e de Cirurgia Vascular; 2015. [citado 2022 julho 12]. https://sbacvsp.com.br/wp-content/uploads/2016/05/doenca-carotidea-extracraniana.pdf.

26 Brott TG, Halperin JL, Abbara S, et al. 2011ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Stroke. 2011;42(8):e420-63. PMid:21282494.

27 Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011;54(3):e1-31. http://dx.doi.org/10.1016/j.jvs.2011.07.031. PMid:21889701.

28 National Institute for Health and Clinical Excellence - NICE. Carotid artery stent placement for asymptomatic extracranial carotid stenosis. Londres: NICE; 2011. [citado 2022 julho 12]. https://www.nice.org.uk/guidance/ipg388.

29 Hobson RW 2nd, Mackey WC, Ascher E, et al. Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2008;48(2):480-6. http://dx.doi.org/10.1016/j.jvs.2008.05.036. PMid:18644494.

30 Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37(6):1583-633. http://dx.doi.org/10.1161/01.STR.0000223048.70103.F1. PMid:16675728.

31 Betteridge DJ, Belch J, Brown MM, et al. Guidelines on the management of secondary prophylaxis of vascular events in stable patients in primary care. Int J Clin Pract. 2004;58(2):153-68. http://dx.doi.org/10.1111/j.1368-5031.2004.0109.x. PMid:15055864.

32 Sabharwal S, Patel V, Nijjer SS, et al. Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument. J R Soc Med. 2013;106(8):315-22. http://dx.doi.org/10.1177/0141076813486261. PMid:23759888.

33 Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999;281(20):1900-5. PMid:10349893.

34 Hoffmann-Eßer W, Siering U, Neugebauer EAM, Brockhaus AC, McGauran N, Eikermann M. Guideline appraisal with AGREE II: online survey of the potential influence of AGREE II items on overall assessment of guideline quality and recommendation for use. BMC Health Serv Res. 2018;18(1):143. http://dx.doi.org/10.1186/s12913-018-2954-8. PMid:29482555.

35 Brouwers MC, Kho ME, Browman GP, et al. Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ. 2010;182(10):E472-8. http://dx.doi.org/10.1503/cmaj.091716. PMid:20513779.

36 Antoniou GA, Mavridis D, Tsokani S, et al. Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery. BMJ Open. 2020;10(8):e037107. http://dx.doi.org/10.1136/bmjopen-2020-037107. PMid:32784259.

37 Zhang P, Lu Q, Li H, et al. The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument. PLoS One. 2019;14(9):e0217555. http://dx.doi.org/10.1371/journal.pone.0217555. PMid:31545806.
 


Submitted date:
03/09/2022

Accepted date:
07/12/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
637d1653a95395038a2f7a52 jvb Articles

J Vasc Bras

Share this page
Page Sections