Difficult airway management: An analysis of systematic review evidence underpinning clinical practice guidelines

Background: Systematic reviews (SRs) underpin the recommendations in clinical practice guidelines (CPGs) for difficult airway management (DAM), yet their methodological and reporting quality varies, potentially impacting clinical decision-making and patient outcomes. Accurate evidence-based medicine is crucial for healthcare workers to make informed decisions in managing a difficult airway, ensuring safer practices and improved outcomes. This study evaluates these SRs using PRISMA and AMSTAR-2 tools to provide insights into their reliability and identify areas for improvement. Methods: A comprehensive PubMed search identified DAM CPGs published between 2015 and 2021. SRs cited within these CPGs were screened for eligibility and assessed using the PRISMA and AMSTAR-2 checklists to evaluate reporting clarity and methodological rigor. A secondary analysis compared quality scores between Cochrane and non-Cochrane SRs, emphasizing their relative contribution to guideline quality and applicability. Results: Fourteen CPGs yielded 63 SRs, 20 of which directly informed guideline recommendations. The mean PRISMA and AMSTAR-2 completion scores for these SRs were 73.4% and 49.3%, respectively, with most SRs rated as moderate or critically low in quality. Only three Cochrane SRs were included, scoring higher on AMSTAR-2 than non-Cochrane SRs. Conclusion: SRs cited in DAM CPGs demonstrate inconsistent quality, reflecting a need for stricter adherence to reporting and methodological standards. Limited use of Cochrane SRs may reduce the robustness of recommendations. Incorporating higher-quality SRs, particularly from Cochrane, and ensuring rigorous evaluation during guideline development are critical for enhancing DAM CPGs’ reliability, applicability, and impact on clinical practice and patient care.