@article{448fc57922fc4a088d841d74df2df4b2,
title = "Methodological and reporting quality of systematic reviews referenced in the clinical practice guideline for pediatric high-blood pressure",
abstract = "Objective: To examine the quality of evidence supporting the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Methods: Methodological and reporting quality of systematic reviews in the Key Action Statements, Consensus Opinions, and in the reference list were assessed using AMSTAR and The PRISMA checklist. Results: For the systematic reviews within the American Academy of Pediatrics' Guideline as a whole (n=27), a mean of 47.8% of AMSTAR items were appropriately addressed, and a mean of 61% of PRISMA were appropriately reported. The means for items adhered to in the systematic reviews cited by Key Action Statements (n=6) were 44.6% for AMSTAR and 67% for PRISMA. The means for items adhered to in the systematic reviews cited by consensus opinion (n=10) were 41.6% for AMSTAR and 54% for PRISMA. Overall, the AMSTAR and PRISMA scores were highly correlated (r=0.77). Conclusion: This study further substantiates the call for more quality evidence-based research in pediatric hypertension. The overall methodological and reporting quality of the systematic reviews were lacking in the American Academy of Pediatrics Guideline. Assessment of risk of bias across studies, identification of an accessible protocol, full disclosure of the role of funding entities, funding of included studies, and a complete PICOS statement were areas of greatest concern. These deficiencies should be addressed in future research in pediatric hypertension.",
keywords = "Evidence-based medicine, Hypertension, Pediatrics, Quality evidence, Systematic reviews",
author = "Kaleb Vaughn and Mason Skinner and Victoria Vaughn and Cole Wayant and Matt Vassar",
note = "Funding Information: Most systematic reviews failed to report the role of the entities funding the review. Intervention into studies by funders has been reported in the form of guest authorship and ghostwriting [37,38], Aware of these incidents, providers are influenced by these important disclosures, and are often influenced by reporting [39]. The authors of AMSTAR acknowledge that identifying and disclosing the funding source of all the primary studies is a challenging task [40]; however, the consequence of not adhering to this AMSTAR item is a lack of transparency in the resulting summary effects [40]. Another overall area of deficiency was the assessment for risk of bias across studies, including publication bias. These assessments are essential to measure the robustness and validity of systematic review summary effect estimates. Inadequate publication bias assessments decrease confidence in the summary effect estimate, as unpublished studies with negative results may alter the level of significance reported in the systematic review [41]. Most are familiar with assessment of risk of bias in individual studies, but risk of bias across studies is a problem uniquely troublesome to clinical practice guidelines, which make recommendations regarding interventions using data across studies [42–46]. Bias across studies occurs because of poor consistency, methodological quality, and generalizability when data are combined across studies [47]. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is the most widely used tool for assessing risk of bias across studies, and has been implemented by some major journals, including Cochrane Reviews [48]. GRADE helps determine the validity of estimates of benefits and harms of any given intervention, and assesses the strength of a guideline recommendation from the quality of the collected evidence as a whole [49]. The vast majority of systematic reviews in the AAP Guideline [14] also lacked an accessible preestablished protocol registered in a database. In absence of an accessible protocol, the assessment of selective reporting bias is limited, and allows for unmonitored deviation from original study designs by authors [50,51]. The International prospective register of systematic reviews (PROSPERO), a registry developed by the Centre for Reviews and Dissemination funded by the National Institute for Health Research is a widely used option [52]. Lastly, few of the systematic reviews had an explicit statement defining the PICOS. A PICOS statement allows the reader to fully understand the scope of what the author is trying to communicate, and the question attempting to be answered [25]. The paucity of systematic reviews likely because of a lack of randomized control trials (RCT) in pediatric hypertension, a common problem throughout pediatric medicine [53]. Factors contributing to the lack of RCTs include the need for proxy consent, lack of funding, small sample sizes, and regulatory hurdles [54,55]. This has been recognized by the scientific community, and legislation has been introduced in many countries to promote pediatric RCTs [55]. Publisher Copyright: {\textcopyright} 2018 Wolters Kluwer Health, Inc.",
year = "2019",
month = mar,
doi = "10.1097/HJH.0000000000001870",
language = "English",
volume = "37",
pages = "488--495",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "3",
}