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

作者：Hoffmann Esser Wiebke^*; Siering Ulrich; Neugebauer Edmund A M; Lampert Ulrike; Eikermann Michaela

来源：Journal of Clinical Epidemiology, 2018, 95: 120-127.

DOI：10.1016/j.clinepi.2017.12.009

• Clinical
• practice guidelines
• Methodological guideline appraisal
• Methodological quality
• Systematic reviews
• AGREE instrument
• practice guidelines as topic

Objectives: To investigate whether Appraisal of Guidelines for Research & Evaluation (AGREE) II users apply a cut-off based on standardized domain scores or overall guideline quality to distinguish between high- and low-quality guidelines, as well as to investigate which criteria they use to generate this cut-off and which type of cut-off they apply.
Study Design and Setting: We conducted a systematic search in MEDLINE, EMBASE, DARE, and the HTA-database for German and English-language studies appraising guidelines with AGREE II. Information on cut-offs was extracted and analyzed descriptively.
Results: We identified 118 relevant publications. Thirty-nine (33%) used a cut-off, of which 24 (62%) used a 2-step and 13 (33%) used a 3-step approach. The cut-off for high quality lay between 50% and 70% (2-step) and 60% and 83% (3-step) of the highest possible rating. Twenty-four (62%) publications applied a cut-off based on standardized domain scores and 7 (18%) based on overall guideline quality. Eleven (28%) applied cut-offs to derive the recommendation for guideline use.
Conclusion: A third of AGREE II users apply a cut-off to distinguish between high- and low-quality guidelines, often without clearly describing how the cut-off is generated. Many users might welcome a clear distinction between high- and low-quality guidelines; specifying a cut-off for this purpose might be useful.

• 出版日期2018-3