Clinical practice guidelines in adult diagnostic flexible bronchoscopy: systematic review of the literature and quality appraisal with AGREE II

Background: Numerous guidelines pertaining to adult diagnostic flexible bronchoscopes (FBs) have been published by Chinese and international organizations, but, to date, there has been no report on their quality. This study aimed to evaluate the quality of existing guidelines for adult diagnostic FB examination using the Appraisal of Guidelines for Research & Evaluation Instrument II (AGREE II), and its main recommendations were summarized to provide a reference for clinical professionals.

Methods: A search was conducted for guidelines related to adult diagnostic FB published in China and internationally. Three researchers independently evaluated the six fields in AGREE II and verified the internal reliability by calculating the intraclass correlation coefficient (ICC). The included guidelines were grouped according to whether the first author's nationality was Chinese, divided into Chinese and international groups, and independent sample t-test was used to compare the differences between the two groups. The main recommendations and evidence of the guidelines, such as indications, contraindications, preoperative preparation, sedation and anesthesia, and intraoperative and postoperative complications, were summarized, categorized, and analyzed.

Results: After a systematic literature search, a total of 11 guidelines were included. The quality level of 10 guidelines was rated as B, which could be recommended after slight modification and improvement. The quality level of one guideline was rated as C, which was not recommended, and the non-quality level was rated as A. The scores of Chinese guidelines were generally lower than those of international ones, and the differences in domain 3 (rigor) (P=0.001) and domain 5 (applicability) (P=0.04) were statistically significant. The ICC of the final evaluation was greater than 0.8, indicating that the researchers were almost completely consistent.

Conclusions: Few existing clinical guidelines meet the standards of quality established by the AGREE II appraisal instrument; Chinese guidelines are generally of a lower quality than those conducted in countries other than China.