不同数据库和语言中关于儿童发热和中性粒细胞减少症管理建议的差异：临床实践指南的系统综述。
完整摘要 · 中文译文
背景：中性粒细胞减少伴发热（FN）是癌症治疗中常见的并发症，与显著的发病率、死亡率和资源使用相关。临床医生目前可能获取多部儿童FN临床实践指南（CPG）以指导决策，然而内容差异可能影响全球范围内的诊疗。我们对CPG进行了系统评价和内容分析，以评估所检索数据库和发表语言对儿童FN所识别建议的数量、质量和内容的影响。 方法：我们对PubMed、Embase和Web of Science数据库进行了系统检索，以识别过去10年内发表的针对儿童FN的循证CPG。我们按语言对CPG进行分类，提取建议，对建议类型（诊断性、预后性或治疗性）、方向及与近期制定的国际指南的一致性进行特征描述。方法学质量采用AGREE-II工具进行评估，英语与非英语CPG之间的比较采用Mann-Whitney U检验。建议类型（治疗、预后、诊断）及与参考指南一致性的比较采用卡方检验。 结果：14部CPG符合纳入标准。10部以英语发表，4部以非英语语言发表。除范围与目的领域外（95.2%对90.5%；p = 0.036），各语言类别在AGREE-II各领域的方法学质量方面无显著差异。每个数据库各收录1部独有指南，14部中仅36%（5/14） 该临床实践指南（CPG）被收录于三个数据库中。14部CPG所涵盖的推荐意见与参考CPG之间的百分比一致率介于33%至100%之间。 结论：以儿童发热性中性粒细胞减少症（FN）作为索引主题，我们发现语言或数据库限制会限缩推荐意见的数量与内容。由于CPG无论来源如何其方法学质量参差不齐，临床医生应基于具体情境设计适当的检索策略。当不同机构的医疗背景或疾病患病率存在差异时，我们推荐采用广泛的检索策略。
完整摘要 · 英文原文
BACKGROUND: Fever with neutropenia (FN) is a common complication of cancer therapy associated with significant morbidity, mortality, and resource use. Clinicians currently may access multiple Clinical Practice Guidelines (CPG) for FN in children to guide decision-making, however variation in content could impact care globally. We performed a systematic review and content analysis of CPG to assess the impact of databases searched and publication language on the quantity, quality, and content of recommendations identified for pediatric FN. METHODS: We conducted a systematic search of PubMed, Embase, and Web of Science databases to identify evidence-based CPG published in the last 10 years addressing FN in children. We categorized CPG by language, extracted recommendations, characterized recommendation type (diagnostic, prognostic, or treatment), direction, and agreement with a recently developed international guideline. Methodological quality was assessed using the AGREE-II instrument and comparison between English and non-English CPG was performed using the Mann-Whitney U test. Comparisons of recommendation type (treatment, prognosis, diagnosis) and agreement with a reference guideline were assessed using the Chi-square test. RESULTS: Fourteen CPG met inclusion criteria. Ten were published in English and four in non-English languages. There was no significant difference in methodological quality between language categories across AGREE-II domains except for scope and purpose (95.2% versus 90.5%; p = 0.036). Each database contained one unique guideline and only 36% (5/14) of the CPG were indexed in three databases. Percentage agreement between recommendations covered by 14 CPG and the reference CPG ranged between 33% and 100%. CONCLUSIONS: Using pediatric FN as an index topic, we found that language or database restrictions limit the quantity and content of recommendations. Since CPG have variable methodological quality regardless of source, clinicians should design appropriate search strategies based on context. We recommend a broad search strategy when healthcare context or disease prevalence differs across settings.