Article type
Year
Abstract
Background:
Since the outbreak of the COVID-19, a large number of guidelines and consensus statements have been developed, but the quality of the cited evidence and the recommendations are unclear.
Objectives:
Systematically analyze the cited evidence of COVID-19 guidelines and consensus statements, compare the recommendations of existing evidence to provide the guidance for clinicians.
Methods:
We searched PubMed, Embase, CBM, CNKI and Wanfang Data from December 1, 2019 to April 1, 2020. In addition, and also searched some official websites including US CDC, European CDC, National Health Commission of the People's Republic of China and some pre-print servers. Two trained researchers conducted the study selection and data extraction independently, then the third researcher checked the results. The information we extracted includes baseline characteristics, guideline and consensuses statements development information and recommendations. Finally, we systematically analyze the extracted information.
Results:
A total of 77 records (24 guidelines and 53 consensus statements) from China (57, 74.0%), the US (10, 13.0%), WHO (6, 7.8%) and Europe (4, 5.2%) were included. A total of 990 references were cited, with an average of 13 (0 to 90) references. 21 (27.3%) guidelines and consensus statements did not cite references. Guidelines cited more systematic reviews [OR=6.71, 95%CI(3.26,13.83), P=0.00], RCTs[OR=2.11, 95%CI(1.03,4.32), P=0.04], and SARS/MERS studies [OR=3.31, 95%CI (2.39,4.60), P=0.00] than consensus statements. More systematic reviews [OR=3.09, 95%CI (1.59,6,03), P=0.00]and SARS/MERS studies [OR=2.63, 95%CI (1.78,3.88), P=0.00] were cited in international guidelines and consensus statements. Guidelines and consensus statements published by associations cited more systematic reviews [OR=0.45, 95%CI(0.23,0.88),P=0.02], RCTs [OR=0.42,95%CI(0.19,0.92),P=0.03] and SARS/MERS studies[OR=0.34,95%CI(0.24,0.48), P=0.00] than which published by non-associations. Thirty-one guidelines and consensus statements (40.26%) include the contains of diagnosis, of which, nucleic acid detection was the most recommended. Thirty-one guidelines and consensus statements (40.26%) include the contains of treatment, of which, 19 guidelines and consensus statements (24.68%) covered general treatment, 19 guidelines and consensus statements (24.68%) refereed to antiviral therapy, and 18 guidelines and consensus statements (23.38%) with oxygen therapy. Finally, main recommendations were extracted and summarized, and twenty-three recommendations were formed, including 3 for diagnosis, 12 for treatment, 3 for special population, and 5 for other aspects.
Conclusions:
Current COVID-19 guidelines and consensus statements are based on less evidence and recommendations from different guidelines and consensus statements are inconsistent. More original researches should be conducted, and the quality of guidelines and consensus statements should be strengthened.
Patient or healthcare consumer involvement: None.
Since the outbreak of the COVID-19, a large number of guidelines and consensus statements have been developed, but the quality of the cited evidence and the recommendations are unclear.
Objectives:
Systematically analyze the cited evidence of COVID-19 guidelines and consensus statements, compare the recommendations of existing evidence to provide the guidance for clinicians.
Methods:
We searched PubMed, Embase, CBM, CNKI and Wanfang Data from December 1, 2019 to April 1, 2020. In addition, and also searched some official websites including US CDC, European CDC, National Health Commission of the People's Republic of China and some pre-print servers. Two trained researchers conducted the study selection and data extraction independently, then the third researcher checked the results. The information we extracted includes baseline characteristics, guideline and consensuses statements development information and recommendations. Finally, we systematically analyze the extracted information.
Results:
A total of 77 records (24 guidelines and 53 consensus statements) from China (57, 74.0%), the US (10, 13.0%), WHO (6, 7.8%) and Europe (4, 5.2%) were included. A total of 990 references were cited, with an average of 13 (0 to 90) references. 21 (27.3%) guidelines and consensus statements did not cite references. Guidelines cited more systematic reviews [OR=6.71, 95%CI(3.26,13.83), P=0.00], RCTs[OR=2.11, 95%CI(1.03,4.32), P=0.04], and SARS/MERS studies [OR=3.31, 95%CI (2.39,4.60), P=0.00] than consensus statements. More systematic reviews [OR=3.09, 95%CI (1.59,6,03), P=0.00]and SARS/MERS studies [OR=2.63, 95%CI (1.78,3.88), P=0.00] were cited in international guidelines and consensus statements. Guidelines and consensus statements published by associations cited more systematic reviews [OR=0.45, 95%CI(0.23,0.88),P=0.02], RCTs [OR=0.42,95%CI(0.19,0.92),P=0.03] and SARS/MERS studies[OR=0.34,95%CI(0.24,0.48), P=0.00] than which published by non-associations. Thirty-one guidelines and consensus statements (40.26%) include the contains of diagnosis, of which, nucleic acid detection was the most recommended. Thirty-one guidelines and consensus statements (40.26%) include the contains of treatment, of which, 19 guidelines and consensus statements (24.68%) covered general treatment, 19 guidelines and consensus statements (24.68%) refereed to antiviral therapy, and 18 guidelines and consensus statements (23.38%) with oxygen therapy. Finally, main recommendations were extracted and summarized, and twenty-three recommendations were formed, including 3 for diagnosis, 12 for treatment, 3 for special population, and 5 for other aspects.
Conclusions:
Current COVID-19 guidelines and consensus statements are based on less evidence and recommendations from different guidelines and consensus statements are inconsistent. More original researches should be conducted, and the quality of guidelines and consensus statements should be strengthened.
Patient or healthcare consumer involvement: None.