Abstract

Infantile hemangiomas (IH) are the most common benign tumors of childhood. Timely diagnosis and management of higher-risk IH is key in avoiding permanent disfigurement, visual impairment, and life-threatening airway compromise. Here, we identify and critically appraise existing clinical practice guidelines (CPGs) for IH diagnosis and management. A systematic search of MEDLINE, SCOPUS, and EMBASE was conducted until August 2021. Four independent reviewers assessed each CPG utilizing the Appraisal of Guidelines for Research and Evaluation, 2^nd edition (AGREE II). An scaled domain score of ≥60% demonstrated adequacy in a given domain. Intraclass correlation coefficients (ICC) assessed agreement and scoring consistency between the reviewers. Eight CPGs were eligible and included for critical appraisal. Only one CPG was classified as ‘high quality’, with the remaining seven guidelines being ‘average’ (n = 3) or ‘low’ (n = 4) quality. Six guidelines (75.0%) were conducted via nonsystematic literature searches. The ‘Applicability’ (40.4%±14.0) and ‘Rigor of development’ (46.9%±17.3) domains achieved the lowest scores, while the highest average scores were in ‘Scope and purpose’ (76.7%±11.3) and ‘Editorial independence’ (90.8%±13.0). We found high consistency between the four independent reviewers, with ‘very good’ (n = 5) or ‘good’ (n = 1) interrater reliability in all six AGREE II domains. Based on the AGREE II instrument, there is only one available high-quality consensus statement on the diagnosis and management of IH. Low scores in ‘Rigor of development’ and ‘Applicability’ suggest notable weaknesses in the development process and reporting quality of existing IH CPGs. Future guidelines should be backed by systematic literature searches and focus on guideline clinical translation.

摘要

婴儿血管瘤（IH）是儿童期最常见的良性肿瘤。及时诊断和治疗高风险 IH 是避免永久性毁容、视力障碍和危及生命的气道损害的关键。在这里，我们确定并严格评估现有的 IH 诊断和管理临床实践指南 (CPG)。MEDLINE、SCOPUS 和 EMBASE 的系统检索持续到 2021 年 8 月。四位独立评审员利用《研究与评估指南评估》第二版 ( ^AGREE II) 对每个 CPG 进行了评估。≥60% 的缩放域分数证明了在给定域中的充分性。组内相关系数（ICC）评估评审者之间的一致性和评分一致性。八个 CPG 符合资格并纳入严格评估。只有一种 CPG 被归类为“高质量”，其余 7 个指南的 质量为“一般”( n  = 3) 或“低”( n = 4)。六项指南（75.0%）是通过非系统文献检索进行的。“适用性”（40.4%±14.0）和“开发严谨性”（46.9%±17.3）领域得分最低，而平均得分最高的是“范围和目的”（76.7%±11.3）和“编辑独立性” ”（90.8%±13.0）。我们发现四位独立评审员之间具有高度一致性， 在所有六个 AGREE II 领域中具有“非常好”（ n  = 5）或“良好”（n = 1）的评审者间可靠性。基于 AGREE II 工具，关于 IH 的诊断和管理只有一份可用的高质量共识声明。“开发的严谨性”和“适用性”的低分表明现有 IH CPG 的开发过程和报告质量存在明显弱点。未来的指南应以系统文献检索为支持，并侧重于指南临床翻译。