¹Interdepartmental Division of Critical Care Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
²Departments of Critical Care and Medicine, Unity Health Toronto, St Michael’s Hospital, Toronto, Ontario, Canada
³Departments of Medicine, Critical Care Medicine, Pediatrics and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
⁴Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
⁵School of Medicine, Royal College of Surgeons, Dublin, Ireland
⁶Department of Critical Care Medicine, London Health Sciences Centre, London, Ontario, Canada
⁷Department of Medicine, Western University, London, Ontario, Canada
⁸Physiotherapy and Division of Critical Care, St Joseph’s Healthcare, Hamilton, Ontario, Canada
⁹School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
¹⁰Hamilton Health Sciences, Hamilton, Ontario, Canada
¹¹Dalla Lana School of Public Health and the Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
¹²Canadian Donation and Transplant Research Program, Ottawa, Ontario, Canada
¹³Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
¹⁴Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Academy of Critical Care: Development, Evaluation, and Methodology (ACCADEMY)for the

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Key Points

Question Do clinical practice guidelines (CPGs) that report on pharmacologic treatments of hospitalized patients with COVID-19 meet the National Academy of Medicine standards for trustworthiness?

Findings In this systematic review of 32 CPGs of predominantly low quality, few reported funding sources or conflicts of interest, included a methodologist, described a search strategy or study selection process, or synthesized evidence. Although 14 CPGs (43.8%) made recommendations or suggestions for or against treatments, they infrequently rated the confidence in the quality of the evidence (6 [18.8%]), described potential benefits and harms (6 [18.8%]), or graded the strength of recommendations (5 [15.6%]).

Meaning The findings of this study suggest that few COVID-19 CPGs meet National Academy of Medicine standards for trustworthy guidelines.

Abstract

Importance The COVID-19 pandemic created the need for rapid and urgent guidance for clinicians to manage COVID-19 among patients and prevent transmission.

Objective To appraise the quality of clinical practice guidelines (CPGs) using the National Academy of Medicine (NAM) criteria.

Evidence Review A search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to December 14, 2020, and a search of related articles to February 28, 2021, that included CPGs developed by societies or by government or nongovernment organizations that reported pharmacologic treatments of hospitalized patients with COVID-19. Teams of 2 reviewers independently abstracted data and assessed CPG quality using the 15-item National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) instrument.

Findings Thirty-two CPGs were included in the review. Of these, 25 (78.1%) were developed by professional societies and emanated from a single World Health Organization (WHO) region. Overall, the CPGs were of low quality. Only 7 CPGs (21.9%) reported funding sources, and 12 (37.5%) reported conflicts of interest. Only 5 CPGs (15.6%) included a methodologist, described a search strategy or study selection process, or synthesized the evidence. Although 14 CPGs (43.8%) made recommendations or suggestions for or against treatments, they infrequently rated confidence in the quality of the evidence (6 of 32 [18.8%]), described potential benefits and harms (6 of 32 [18.8%]), or graded the strength of the recommendations (5 of 32 [15.6%]). External review, patient or public perspectives, or a process for updating were rare. High-quality CPGs included a methodologist and multidisciplinary collaborations involving investigators from 2 or more WHO regions.

Conclusions and Relevance In this review, few COVID-19 CPGs met NAM standards for trustworthy guidelines. Approaches that prioritize engagement of a methodologist and multidisciplinary collaborators from at least 2 WHO regions may lead to the production of fewer, high-quality CPGs that are poised for updates as new evidence emerges.

Trial Registration PROSPERO Identifier: CRD42021245239

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Article Information

Accepted for Publication: September 14, 2021.

Published: December 10, 2021. doi:10.1001/jamanetworkopen.2021.36263

Corresponding Author: Karen E. A. Burns, MD, MSc (Epid), Unity Health Toronto, St Michael’s Hospital, 30 Bond St, 4-045 Donnelly Wing, Toronto, Ontario, Canada M5B 1W8 (karen.burns@unityhealth.to).

Author Contributions: Dr Burns had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Burns, Laird, Stevenson, Kho, Friedrich, Meade, Duffett, Adhikari, Noh, Rochwerg.

Acquisition, analysis, or interpretation of data: Burns, Laird, Stevenson, Honarmand, Granton, Kho, Cook, Friedrich, Meade, Duffett, Chaudhuri, Liu, D’Aragon, Agarwal, Adhikari, Rochwerg.

Drafting of the manuscript: Burns, Laird, Stevenson, Noh.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Burns, Duffett, Liu, Rochwerg.

Administrative, technical, or material support: Burns, Laird, Stevenson, Cook, Friedrich, Chaudhuri, Agarwal, Rochwerg.

Supervision: Burns, Meade, Rochwerg.

Conflict of Interest Disclosures: Dr Burns reported holding a career award from the Physician Services Incorporated Foundation. Dr Kho reported receiving grants from Canada Research Chairs outside the submitted work. Dr Adhikari reported serving as chair for COVID-19 guideline panels convened by the World Health Organization. No other disclosures were reported.

Group Information: The Academy of Critical Care: Development, Evaluation, and Methodology (ACCADEMY) collaborators are listed in Supplement 2.

Additional Contributions: David Lightfoot, MISt, Unity Health Toronto, St Michael’s Hospital, assisted in conducting the literature searches. Mr Lightfoot did not receive remuneration for his assistance.

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Adherence of Clinical Practice Guidelines for Pharmacologic Treatments of Hospitalized Patients With COVID-19 to Trustworthy StandardsA Systematic Review

Clinical Practice Guidelines of Pharmacological Treatments for Hospitalized Patients With COVID-19

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