近日，英国牛津大学Andrew Dagens团队评估了covid-19大流行早期临床指南的质量。相关论文于2020年5月26日发表在《英国医学杂志》上。

为了评估在covid-19大流行早期制定的临床指南的可用性、质量和包容性，研究组在Ovid Medline、Ovid Embase、Ovid Global Health、科学引文索引等大型数据库中检索从建库至2020年3月14日的文献，筛选出国际和国家科学组织以及政府和非政府组织制定的与全球健康有关的covid-19、中东呼吸综合征（MERS）和严重急性呼吸综合征（SARS）的管理临床指南，仅收入所有指南的最早版本，对符合标准的文献进行快速审查。使用《指南研究与评价》评审工具（AGREE）II对质量进行评估。

共有42条指南纳入最终分析，其中18条针对covid-19。总体而言，临床指南缺乏细节，涵盖的主题范围很窄。关于诸如抗病毒药物使用的建议各不相同。总体质量很差，特别是在利益相关者的参与、适用性和编辑独立性方面。证据和建议之间的联系很有限。且很少提及孕妇、儿童和老年人等弱势群体。

总之，在covid-19大流行中早期制定的指南在方法论上存在缺陷，且忽略了像老年人之类的弱势群体。在公共卫生紧急情况下制定临床指南需要一个框架，以确保方法严谨，并将弱势人群包括在内。

附：英文原文

Title: Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: rapid review

Author: Andrew Dagens, Louise Sigfrid, Erhui Cai, Sam Lipworth, Vincent Cheung, Eli Harris, Peter Bannister, Ishmeala Rigby, Peter Horby

Issue&Volume: 2020/05/26

Abstract: Objective To appraise the availability, quality, and inclusivity of clinical guidelines produced in the early stage of the coronavirus disease 2019 (covid-19) pandemic.

Design Rapid review.

Data sources Ovid Medline, Ovid Embase, Ovid Global Health, Scopus, Web of Science Core Collection, and WHO Global Index Medicus, searched from inception to 14 Mar 2020. Search strategies applied the CADTH database guidelines search filter, with no limits applied to search results. Further studies were identified through searches of grey literature using the ISARIC network.

Inclusion criteria Clinical guidelines for the management of covid-19, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) produced by international and national scientific organisations and government and non-governmental organisations relating to global health were included, with no exclusions for language. Regional/hospital guidelines were excluded. Only the earliest version of any guideline was included.

Quality assessment Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The quality and contents of early covid-19 guidelines were also compared with recent clinical guidelines for MERS and SARS.

Results 2836 studies were identified, of which 2794 were excluded after screening. Forty two guidelines were considered eligible for inclusion, with 18 being specific to covid-19. Overall, the clinical guidelines lacked detail and covered a narrow range of topics. Recommendations varied in relation to, for example, the use of antiviral drugs. The overall quality was poor, particularly in the domains of stakeholder involvement, applicability, and editorial independence. Links between evidence and recommendations were limited. Minimal provision was made for vulnerable groups such as pregnant women, children, and older people.

Conclusions Guidelines available early in the covid-19 pandemic had methodological weaknesses and neglected vulnerable groups such as older people. A framework for development of clinical guidelines during public health emergencies is needed to ensure rigorous methods and the inclusion of vulnerable populations.

DOI: 10.1136/bmj.m1936

Source: https://www.bmj.com/content/369/bmj.m1936