Quality Assessment of Clinical Guidelines in the Care of Laryngitis and Pharyngitis According to AGREE II

Overview

Journal Codas

Date 2025 Jan 29

PMID 39879424

Authors

Lucas Mateus Rodrigues Carvalho

Ana Paula de Oliveira Barbosa

Nara Amanda Laismann

Debora Santos Lula Barros

Rodrigo Fonseca Lima

Rafael Santos Santana

Affiliations

Soon will be listed here.

Abstract

Purpose: The study aimed to identify and assess the methodological quality of essential clinical guidelines for the management of laryngitis and pharyngitis.

Methods: A systematic search of clinical guidelines for the management of laryngitis and pharyngitis was performed in three databases. Methodological quality was assessed according to AGREE II, in which each item in its domains was scored by four independent evaluators. To determine the agreement, a weighted Kappa square statistic calculation was performed.

Results: 81 studies were found in the bibliographic sources consulted and all were evaluated. Considering the exclusion criteria, seven guidelines were selected for final evaluation by AGREE II. The squared weighted Kappa coefficient calculated after the first round of evaluation by AGREE II was 0.85, within an almost perfect agreement rate. The domains "stakeholder engagement", "applicability", and "editorial independence" had the lowest mean scores and the highest standard deviation indices. They had, respectively, a mean score of (63.7%) with a standard deviation of (17%), a mean score of (65.7%) with a standard deviation of (22%), and a mean score of (35%) with a standard deviation of (23%). The use of penicillin, erythromycin, ampicillin, amoxicillin, azithromycin and clarithromycin were recommended in (75%) of all guidelines that presented pharmacological measures. As a non-pharmacological measure, oral rehydration and gargling were recommended by two guidelines.

Conclusion: The statistical results indicate that all guidelines were considered as recommended. However, no uniformity was observed in the recommendations of these seven guidelines with regard to non-pharmacological and pharmacological treatment.

References

Rohde A, Worrall L, Le Dorze G . Systematic review of the quality of clinical guidelines for aphasia in stroke management. J Eval Clin Pract. 2013; 19(6):994-1003. DOI: 10.1111/jep.12023. View

Reveiz L, Cardona A . Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2015; (5):CD004783. PMC: 6486127. DOI: 10.1002/14651858.CD004783.pub5. View

Francis D, Smith L . Hoarseness Guidelines Redux: Toward Improved Treatment of Patients with Dysphonia. Otolaryngol Clin North Am. 2019; 52(4):597-605. DOI: 10.1016/j.otc.2019.03.003. View

Robinson J . Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance. Drugs Context. 2021; 10. PMC: 8007209. DOI: 10.7573/dic.2020-11-6. View

Galvao C, Sawada N, Rossi L . [Evidence based practice: theoretical considerations for its implementation in perioperative nursing]. Rev Lat Am Enfermagem. 2003; 10(5):690-5. DOI: 10.1590/s0104-11692002000500010. View

Anwer M, Al-Fahed O, Arif S, Amer Y, Titi M, Al-Rukban M . Quality assessment of recent evidence-based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument. J Eval Clin Pract. 2017; 24(1):166-172. DOI: 10.1111/jep.12785. View

Santana R, Lupatini E, Zanghelini F, de March Ronsoni R, Rech N, Leite S . The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases. PLoS One. 2018; 13(10):e0204723. PMC: 6192575. DOI: 10.1371/journal.pone.0204723. View

Cots J, Alos J, Barcena M, Boleda X, Canada J, Gomez N . Recommendations for management of acute pharyngitis in adults. Acta Otorrinolaringol Esp. 2015; 66(3):159-70. PMC: 7124194. DOI: 10.1016/j.otorri.2015.01.001. View

Kruger K, Topfner N, Berner R, Windfuhr J, Oltrogge J . Clinical Practice Guideline: Sore Throat. Dtsch Arztebl Int. 2021; 118(11):188-94. PMC: 8245861. DOI: 10.3238/arztebl.m2021.0121. View

10.

Chiappini E, Mazzantini R, Bruzzese E, Capuano A, Colombo M, Cricelli C . Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics. Paediatr Respir Rev. 2014; 15(3):231-6. DOI: 10.1016/j.prrv.2013.11.011. View

11.

Vaz J, Alves B, Duarte D, Marques L, Santana R . Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II's method. Cephalalgia. 2021; 42(3):239-249. DOI: 10.1177/03331024211037297. View

12.

Wood J, Athanasiadis T, Allen J . Laryngitis. BMJ. 2014; 349:g5827. DOI: 10.1136/bmj.g5827. View

13.

Stachler R, Francis D, Schwartz S, Damask C, Digoy G, Krouse H . Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg. 2018; 158(1_suppl):S1-S42. DOI: 10.1177/0194599817751030. View

14.

Shulman S, Bisno A, Clegg H, Gerber M, Kaplan E, Lee G . Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012; 55(10):1279-82. DOI: 10.1093/cid/cis847. View

15.

Hoffmann-Esser W, Siering U, Neugebauer E, Lampert U, Eikermann M . Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument-a third of AGREE II users apply a cut-off for guideline quality. J Clin Epidemiol. 2017; 95:120-127. DOI: 10.1016/j.jclinepi.2017.12.009. View

16.

Matthys J, De Meyere M, Van Driel M, De Sutter A . Differences among international pharyngitis guidelines: not just academic. Ann Fam Med. 2007; 5(5):436-43. PMC: 2000301. DOI: 10.1370/afm.741. View

17.

Chorath K, Prasad A, Luu N, Go B, Moreira A, Rajasekaran K . Critical review of clinical practice guidelines for evaluation of neck mass in adults. Braz J Otorhinolaryngol. 2021; 88(4):625-632. PMC: 9422615. DOI: 10.1016/j.bjorl.2021.03.005. View

18.

Hoffmann-Esser W, Siering U, Neugebauer E, Brockhaus A, Lampert U, Eikermann M . Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments. PLoS One. 2017; 12(3):e0174831. PMC: 5373625. DOI: 10.1371/journal.pone.0174831. View

19.

Chiappini E, Regoli M, Bonsignori F, Sollai S, Parretti A, Galli L . Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther. 2011; 33(1):48-58. DOI: 10.1016/j.clinthera.2011.02.001. View

20.

Shaneyfelt T, Rothwangl J . Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999; 281(20):1900-5. DOI: 10.1001/jama.281.20.1900. View