Analysis on Status of Clinical Guidelines and Evaluation on Evidence-Based Guidelines of Children in China_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Lingli ,  LI Youping ¹ , ZHANG Chuan ² , HUANG Liang ¹ , LIANG Yi ¹ , HAN Lu ^1,3

1. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, China;2. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China2. School of Pharmacy, Sichuan University, Chengdu 610041, China;

Corresponding?author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Children; Clinical guideline; Evidence-based guideline

DOI：

10.7507/1672-2531.20110166

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To investigate and analyze the status of clinical guidelines of children in China, so as to regulate the development of children’s evidence-based clinical guidelines and provide recommendations for children’s clinical guidelines.
Methods 　Names of guidelines, year and institution of publication, methodology of development and reference number were descriptively analyzed. Years of publication and diseases of guidelines were analyzed with statistical graphs. AGREE instrument was used to evaluate the evidence-based guidelines of children.
Results 　a) Of 91 clinical guidelines of children, 62 were translations. Of 29 guidelines ourselves, nine were traditional Chinese medicine guidelines and five (17%) were evidence-based guidelines; b) Guideline on Rational Use of Antibiotics in Acute Respiratory Infections (Probation), the first guideline of children, was published in 1999. Guidelines of children was not published until 2005. Then, the number of guidelines was increasing each year and reached a peak in 2008. Of 13 guidelines in 2008, seven were traditional Chinese medicine guidelines. Guidelines on respiratory diseases were 14 ranked as the top; c) Guidelines on congenital deformity and chromosomal abnormalities, tumor, circulatory system disease, blood disease and western guideline on communicable disease were not formulated in China; and d) Average scores on six domain of five evidence-based guidelines were 84.4%, 37.5%, 74.3%, 90.0%, 22.2%, 46.6%, respectively. Guide on Diagnosis and Treatment of Children Aged 0 to 5 with Acute Fever of Unknown Etiology was bly recommended, Guide on Management of Children with Community-Acquired Pneumonia, Evidence-Based Guide on Diagnosis and Treatment of Children with Common Kidney Disease, Guide on Nutrition Support of Newborn, Guide on Diagnosis and Treatment of Children with Chronic Cough were recommended.
Conclusion 　Clinical guidelines of children in China begin late, develop slowly and are lack of update. A standard on development of guidelines is needed. The government should increase the fund of development, implementation and promotion of guidelines. Recommendations for high-quality guidelines should be included in procedure of medical quality assurance. Compliance of guidelines should be provided by organization which formulatesd the guideline, so as to promote the application of high-quality guidelines.

Citation： ZHANG Lingli,LI Youping,ZHANG Chuan,HUANG Liang,LIANG Yi,HAN Lu. Analysis on Status of Clinical Guidelines and Evaluation on Evidence-Based Guidelines of Children in China. Chinese Journal of Evidence-Based Medicine, 2011, 11(9): 991-999. doi: 10.7507/1672-2531.20110166 Copy

1.	1 Woolf SH, Grol R, Hutchinson A, et al . Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ , 1999, 318(7182): 527-530.
2.	Boluyt N, Lincke CR, Offringa M. Quality of evidence-based pediatric guidelines. Pediatrics , 2005, 115(5): 1378-1391.
3.	New Zealand Guideline Group website: Scottish Intercollegiate Guidelines Network (SIGN). A guideline developer’s handbook. Edinburgh: SIGN, 2001.
4.	Field MJ, Lohr KN, eds. Guidelines for clinical practice: from development to use. Washington: National Academy Press, 1992.
5.	鄧可剛. 國外制訂循證臨床指南的進展. 中國循證醫學雜志, 2005, 5(4): 335-339.
6.	World Health Organization: Guidelines for WHO Guidelines. In Global Program on Evidence for Health Policy World Health Organization, 2003.
7.	Thomson R, McElroy H, Sudlow M. Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment. BMJ , 1998, 316(7130): 509-513.
8.	Unwin N, Thomson R, O'Byrne AM, et al . Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors. BMJ , 1998, 317(7166): 1125-1130.
9.	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): 1900-1905.
10.	Grilli R, Magrini N, Penna A, et al . Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet , 2000, 355(9198): 103-106.
11.	Vlayen J, Aertgeerts B, Hannes K, et al . A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care , 2005, 17(3):235-242.
12.	AGREE, Appraisal of Guidelines for Research ＆ Evaluation: AGREE Instrument Training Manual. The AGREE Collaboration 2003.
13.	中華醫學會兒科學分會呼吸學組; 陸權, 陳慧中, 江瀾, 等. 急性呼吸道感染抗生素合理使用指南（試行）（下部分）. 中華兒科雜志, 2001, 39(6): 379-383.
14.	虞人杰, 葉鴻瑁, 黃醒華, 等. 新生兒窒息復蘇指南（試行稿）. 中華兒科雜志, 2005, 43(5): 381-384.
15.	早產兒管理指南. 中華兒科雜志, 2006, 44(3): 188-191.
16.	骨軟化癥與佝僂病診療指南（討論稿）. 中華全科醫師雜志, 2006, 5(8): 464-465.
17.	兒童高鉛血癥和鉛中毒預防指南. 中華現代兒科學雜志, 2006, 3(2): 190-190.
18.	兒童社區獲得性肺炎管理指南（試行）（上）. 中華兒科雜志, 2007, 45(2): 83-90.
19.	蔡威. 中國新生兒營養支持臨床應用指南. 中國循證兒科雜志, 2007. 2(4): 282-291.
20.	兒童阻塞性睡眠呼吸暫停低通氣綜合征診療指南草案（烏魯木齊）. 中華耳鼻咽喉頭頸外科雜志, 2007, 42(2): 83-84.
21.	中樞性（真性）性早熟診治指南. 中華兒科雜志, 2007, 45(6): 426-427.
22.	葉鴻瑁, 黎曉新. 早產兒治療用氧和視網膜病變防治指南. 中華兒科雜志, 2007, 45(9): 672-673.
23.	兒童慢性咳嗽診斷與治療指南（試行）. 中華兒科雜志, 2008, 46(2): 104-107.
24.	兒童支氣管哮喘診斷與防治指南. 中華兒科雜志, 2008, 46(10): 745-753.
25.	矮身材兒童診治指南. 中華醫學信息導報, 2008. 23(24): 20-21.
26.	兒童中耳炎診斷和治療指南（草案）. 中華耳鼻咽喉頭頸外科雜志, 2008, 43(12): 884-885.
27.	王藝, 萬朝敏, 中國0至5歲兒童病因不明的急性發熱診斷處理指南（標準版）. 中國循證兒科雜志, 2008, 3(6): 449-457.
28.	腸道病毒(EV71)感染診療指南(2008年版). 熱帶病與寄生蟲學, 2008, (2): 121-121, 68.
29.	兒童糖尿病酮癥酸中毒診療指南（2009年版）. 中華兒科雜志, 2009, 47(6): 421-425.
30.	兒童常見腎臟疾病診治循證指南（一）: 激素敏感、復發/依賴腎病綜合征診治循證指南. 中華兒科雜志, 2009, 47(3): 167-170.
31.	兒童侵襲性肺部真菌感染診治指南（2009版）. 中華兒科雜志, 2009, 47(2): 96-98.
32.	兒童暈厥診斷指南. 中華兒科雜志, 2009, 47(2): 99-101.
33.	韓新民, 汪受傳, 虞舜, 等. 小兒泄瀉中醫診療指南. 中醫兒科雜志, 2008, 4(4): 1-3.
34.	韓新民, 汪受傳, 虞舜, 等. 流行性腮腺炎中醫診療指南. 中醫兒科雜志, 2008, 4(5): 1-3.
35.	李燕寧, 張葆青, 潘月莉, 等. 小兒支氣管炎中醫診療指南. 中醫兒科雜志, 2008, 4(6): 1-3.
36.	汪受傳, 趙霞, 韓新民, 等. 小兒肺炎喘嗽中醫診療指南. 中醫兒科雜志, 2008. 4(3): 1-3.
37.	王力寧, 汪受傳, 韓新民. 小兒反復呼吸道感染中醫診療指南. 中醫兒科雜志, 2008, 4(6): 3-4.
38.	江蘇省中醫藥防治手足口病指南（試行）. 全國藥材信息, 2008, (14): 1-2.
39.	趙霞, 汪受傳, 韓新民, 等. 小兒哮喘中醫診療指南. 中醫兒科雜志, 2008. 4(3): 4-6.
40.	艾軍, 汪受傳, 趙霞, 等. 小兒感冒中醫診療指南. 中醫兒科雜志, 2009. 5(1): 1-3.
41.	馬融, 李新民, 胡思源, 等. 兒童甲型H1N1流感中醫藥防治指南. 中華中醫藥雜志, 2010, 25(1): 103-105.
42.	丁潔. 兒童常見腎臟疾病診治循證指南的制訂及相關問題探討. 中華兒科雜志, 2009, 47(3): 161-162.
43.	唐旭東. 《中醫內科常見病診療指南》研究工作匯報. http://zy.china.com.cn/zhzyyxh/zyybzh/3414.html.
44.	國家中醫藥管理局. 中醫藥標準化發展規劃（2006-2010）. http://www.satcm.gov.cn/e/search/result/?searchid=2418.
45.	中華人民共和國衛生部. 2009中國衛生統計年鑒. http://www.moh.gov.cn/publicfiles/business/htmlfiles/zwgkzt/ptjnj/year2009/t-7.htm.
46.	宋萍. 144,379例住院兒童疾病統計分析. 中國病案, 2010, 11(3): 40-43.
47.	鄭海生, 徐海春, 劉凱, 等. 淺議循證醫學在中醫藥療效評價中的應用意義. 時珍國醫國藥, 2010, 21(7): 1794-1795.
48.	American Academy of Pediatrics. Health Supervision for Children With Down Syndrome PEDIATRICS (ISSN 0031 4005).2004.
49.	French National Agency for Accreditation and Evaluation in Healthcare 2001. Physiotherapy and orthopaedic treatment for isolated congenital foot deformity during the first six months of life. 2004. http://www.has-sante.fr/portail/plugins/ModuleXitiKLEE/types/FileDocument/doXiti.jsp?id=c_268049.
50.	Core interventions in the treatment and management of schizophrenia in primary and secondary care. http://www.nice.org.uk/CG1.
51.	Turner T, Misso M, Harris C, et al . Development of evidence-based clinical practice guidelines (CPGs): comparing approaches. Implement Sci , 2008, 3: 45.
52.	Scottish Intercollegiate Guidelines Network (SIGN). Management of Sore Throat and Indications for Tonsillectomy. SIGN Publication, 1999. http://www.sign.ac.uk.
53.	NZGG: Handbook for the Preparation of Explicit Evidence-Based Clinical Practice Guidelines. New Zealand Guidelines Group, 2001.
54.	New Zealand Guidelines Group. Guidelines for the management of heavy menstrual bleeding, 1998. http//www.nzgg.org.nz.
55.	NICE. Prophylaxis for patients who have experienced a myocardial infarction: drug treatment, cardiac rehabilitation and dietary manipulation, 2000. http://www.nice.org.uk.
56.	Burgers JS, Cluzeau FA, Hanna SE, et al . Characteristics of high-quality guidelines: evaluation of 86 clinical guidelines developed in ten European countries and Canada. Int J Technol Assess Health Care , 2003, 19(1): 148-157.
57.	Burgers JS, Grol R, Klazinga NS, et al . Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care , 2003, 15(1): 31-45.
58.	Council of Europe: Developing a Methodology for Drawing up Guidelines on Best Medical Practice. Committee of Ministers of the Council of Europe, 2001.
59.	NHMRC: A guide to the development, implementation and evaluation of clinical practice guidelines. National Health and Medical Research Council, 1999.
60.	NICE: The Guideline Manual. National Institute for Health and Clinical Excellence, 2007.
61.	SIGN: SIGN 50: A guideline developers' handbook. Scottish Intercollegiate Guideline Network, 2004.
62.	Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care , 1994, 32(3): 202-213.

1. 1 Woolf SH, Grol R, Hutchinson A, et al . Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ , 1999, 318(7182): 527-530.
2. Boluyt N, Lincke CR, Offringa M. Quality of evidence-based pediatric guidelines. Pediatrics , 2005, 115(5): 1378-1391.
3. New Zealand Guideline Group website: Scottish Intercollegiate Guidelines Network (SIGN). A guideline developer’s handbook. Edinburgh: SIGN, 2001.
4. Field MJ, Lohr KN, eds. Guidelines for clinical practice: from development to use. Washington: National Academy Press, 1992.
5. 鄧可剛. 國外制訂循證臨床指南的進展. 中國循證醫學雜志, 2005, 5(4): 335-339.
6. World Health Organization: Guidelines for WHO Guidelines. In Global Program on Evidence for Health Policy World Health Organization, 2003.
7. Thomson R, McElroy H, Sudlow M. Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment. BMJ , 1998, 316(7130): 509-513.
8. Unwin N, Thomson R, O'Byrne AM, et al . Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors. BMJ , 1998, 317(7166): 1125-1130.
9. 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): 1900-1905.
10. Grilli R, Magrini N, Penna A, et al . Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet , 2000, 355(9198): 103-106.
11. Vlayen J, Aertgeerts B, Hannes K, et al . A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care , 2005, 17(3):235-242.
12. AGREE, Appraisal of Guidelines for Research ＆ Evaluation: AGREE Instrument Training Manual. The AGREE Collaboration 2003.
13. 中華醫學會兒科學分會呼吸學組; 陸權, 陳慧中, 江瀾, 等. 急性呼吸道感染抗生素合理使用指南（試行）（下部分）. 中華兒科雜志, 2001, 39(6): 379-383.
14. 虞人杰, 葉鴻瑁, 黃醒華, 等. 新生兒窒息復蘇指南（試行稿）. 中華兒科雜志, 2005, 43(5): 381-384.
15. 早產兒管理指南. 中華兒科雜志, 2006, 44(3): 188-191.
16. 骨軟化癥與佝僂病診療指南（討論稿）. 中華全科醫師雜志, 2006, 5(8): 464-465.
17. 兒童高鉛血癥和鉛中毒預防指南. 中華現代兒科學雜志, 2006, 3(2): 190-190.
18. 兒童社區獲得性肺炎管理指南（試行）（上）. 中華兒科雜志, 2007, 45(2): 83-90.
19. 蔡威. 中國新生兒營養支持臨床應用指南. 中國循證兒科雜志, 2007. 2(4): 282-291.
20. 兒童阻塞性睡眠呼吸暫停低通氣綜合征診療指南草案（烏魯木齊）. 中華耳鼻咽喉頭頸外科雜志, 2007, 42(2): 83-84.
21. 中樞性（真性）性早熟診治指南. 中華兒科雜志, 2007, 45(6): 426-427.
22. 葉鴻瑁, 黎曉新. 早產兒治療用氧和視網膜病變防治指南. 中華兒科雜志, 2007, 45(9): 672-673.
23. 兒童慢性咳嗽診斷與治療指南（試行）. 中華兒科雜志, 2008, 46(2): 104-107.
24. 兒童支氣管哮喘診斷與防治指南. 中華兒科雜志, 2008, 46(10): 745-753.
25. 矮身材兒童診治指南. 中華醫學信息導報, 2008. 23(24): 20-21.
26. 兒童中耳炎診斷和治療指南（草案）. 中華耳鼻咽喉頭頸外科雜志, 2008, 43(12): 884-885.
27. 王藝, 萬朝敏, 中國0至5歲兒童病因不明的急性發熱診斷處理指南（標準版）. 中國循證兒科雜志, 2008, 3(6): 449-457.
28. 腸道病毒(EV71)感染診療指南(2008年版). 熱帶病與寄生蟲學, 2008, (2): 121-121, 68.
29. 兒童糖尿病酮癥酸中毒診療指南（2009年版）. 中華兒科雜志, 2009, 47(6): 421-425.
30. 兒童常見腎臟疾病診治循證指南（一）: 激素敏感、復發/依賴腎病綜合征診治循證指南. 中華兒科雜志, 2009, 47(3): 167-170.
31. 兒童侵襲性肺部真菌感染診治指南（2009版）. 中華兒科雜志, 2009, 47(2): 96-98.
32. 兒童暈厥診斷指南. 中華兒科雜志, 2009, 47(2): 99-101.
33. 韓新民, 汪受傳, 虞舜, 等. 小兒泄瀉中醫診療指南. 中醫兒科雜志, 2008, 4(4): 1-3.
34. 韓新民, 汪受傳, 虞舜, 等. 流行性腮腺炎中醫診療指南. 中醫兒科雜志, 2008, 4(5): 1-3.
35. 李燕寧, 張葆青, 潘月莉, 等. 小兒支氣管炎中醫診療指南. 中醫兒科雜志, 2008, 4(6): 1-3.
36. 汪受傳, 趙霞, 韓新民, 等. 小兒肺炎喘嗽中醫診療指南. 中醫兒科雜志, 2008. 4(3): 1-3.
37. 王力寧, 汪受傳, 韓新民. 小兒反復呼吸道感染中醫診療指南. 中醫兒科雜志, 2008, 4(6): 3-4.
38. 江蘇省中醫藥防治手足口病指南（試行）. 全國藥材信息, 2008, (14): 1-2.
39. 趙霞, 汪受傳, 韓新民, 等. 小兒哮喘中醫診療指南. 中醫兒科雜志, 2008. 4(3): 4-6.
40. 艾軍, 汪受傳, 趙霞, 等. 小兒感冒中醫診療指南. 中醫兒科雜志, 2009. 5(1): 1-3.
41. 馬融, 李新民, 胡思源, 等. 兒童甲型H1N1流感中醫藥防治指南. 中華中醫藥雜志, 2010, 25(1): 103-105.
42. 丁潔. 兒童常見腎臟疾病診治循證指南的制訂及相關問題探討. 中華兒科雜志, 2009, 47(3): 161-162.
43. 唐旭東. 《中醫內科常見病診療指南》研究工作匯報. http://zy.china.com.cn/zhzyyxh/zyybzh/3414.html.
44. 國家中醫藥管理局. 中醫藥標準化發展規劃（2006-2010）. http://www.satcm.gov.cn/e/search/result/?searchid=2418.
45. 中華人民共和國衛生部. 2009中國衛生統計年鑒. http://www.moh.gov.cn/publicfiles/business/htmlfiles/zwgkzt/ptjnj/year2009/t-7.htm.
46. 宋萍. 144,379例住院兒童疾病統計分析. 中國病案, 2010, 11(3): 40-43.
47. 鄭海生, 徐海春, 劉凱, 等. 淺議循證醫學在中醫藥療效評價中的應用意義. 時珍國醫國藥, 2010, 21(7): 1794-1795.
48. American Academy of Pediatrics. Health Supervision for Children With Down Syndrome PEDIATRICS (ISSN 0031 4005).2004.
49. French National Agency for Accreditation and Evaluation in Healthcare 2001. Physiotherapy and orthopaedic treatment for isolated congenital foot deformity during the first six months of life. 2004. http://www.has-sante.fr/portail/plugins/ModuleXitiKLEE/types/FileDocument/doXiti.jsp?id=c_268049.
50. Core interventions in the treatment and management of schizophrenia in primary and secondary care. http://www.nice.org.uk/CG1.
51. Turner T, Misso M, Harris C, et al . Development of evidence-based clinical practice guidelines (CPGs): comparing approaches. Implement Sci , 2008, 3: 45.
52. Scottish Intercollegiate Guidelines Network (SIGN). Management of Sore Throat and Indications for Tonsillectomy. SIGN Publication, 1999. http://www.sign.ac.uk.
53. NZGG: Handbook for the Preparation of Explicit Evidence-Based Clinical Practice Guidelines. New Zealand Guidelines Group, 2001.
54. New Zealand Guidelines Group. Guidelines for the management of heavy menstrual bleeding, 1998. http//www.nzgg.org.nz.
55. NICE. Prophylaxis for patients who have experienced a myocardial infarction: drug treatment, cardiac rehabilitation and dietary manipulation, 2000. http://www.nice.org.uk.
56. Burgers JS, Cluzeau FA, Hanna SE, et al . Characteristics of high-quality guidelines: evaluation of 86 clinical guidelines developed in ten European countries and Canada. Int J Technol Assess Health Care , 2003, 19(1): 148-157.
57. Burgers JS, Grol R, Klazinga NS, et al . Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care , 2003, 15(1): 31-45.
58. Council of Europe: Developing a Methodology for Drawing up Guidelines on Best Medical Practice. Committee of Ministers of the Council of Europe, 2001.
59. NHMRC: A guide to the development, implementation and evaluation of clinical practice guidelines. National Health and Medical Research Council, 1999.
60. NICE: The Guideline Manual. National Institute for Health and Clinical Excellence, 2007.
61. SIGN: SIGN 50: A guideline developers' handbook. Scottish Intercollegiate Guideline Network, 2004.
62. Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care , 1994, 32(3): 202-213.

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Chinese Journal of Evidence-Based Medicine

Analysis on Status of Clinical Guidelines and Evaluation on Evidence-Based Guidelines of Children in China

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