Quality of evidence-based guidelines for platelet transfusion and use: A systematic review

Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Canadian Blood Services, Toronto, Ontario, Canada. Department of Molecular Medicine, Sapienza University, Rome, Italy. Italian National Blood Centre, National Institute of Health, Rome, Italy. Canadian Blood Services, Ottawa, Ontario, Canada. Departments of Medicine, Laboratory Management and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada. Transfusion Medicine, NHS Blood and Transplant, Oxford, UK. Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada. Transfusion Medicine Section, Alberta Precision Laboratories, Edmonton, Alberta, Canada.

Transfusion. 2021
PICO Summary

Population

Guidelines for platelet (PLT) transfusion (7 studies).

Intervention

Systematic review to determine the quality of existing PLT transfusion guidelines and to describe the inconsistencies in recommendations.

Comparison

Outcome

The median scaled score for the following items were as follows: scope and purpose, 94%; stakeholder involvement, 63%; rigor of development, 83%; clarity of presentation, 94%; applicability, 58%; and editorial independence, 77%. Overall quality ranged from 4 to 7 (7 was the maximum score). Inconsistent recommendations were found on prophylactic PLT transfusion in hypoproliferative thrombocytopenia in the presence of risk factors, and dose recommendations.
Abstract
BACKGROUND Guidelines for platelet (PLT) transfusion are an important source of information for clinicians. Although guidelines intend to increase consistency and quality of care, variation in methodology and recommendations may exist that could impact the value of a guideline. We aimed to determine the quality of existing PLT transfusion guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument and to describe the inconsistencies in recommendations. STUDY DESIGN AND METHODS A systematic search was undertaken for evidence-based guidelines from January 1, 2013, to January 25, 2019. Citations were reviewed in duplicate for inclusion and descriptive data extracted. Four physicians appraised the guideline using the AGREE II instrument and the scaled score for each item evaluated was calculated. The protocol was registered in PROSPERO. RESULTS Of 6744 citations, 6740 records were screened. Seven of 28 full-text studies met the inclusion criteria. The median scaled score (and the interquartile range of the scaled score) for the following items were as follows: scope and purpose, 94% (8%); stakeholder involvement, 63% (18%); rigor of development, 83% (14%); clarity of presentation, 94% (6%); applicability, 58% (20%); and editorial independence, 77% (4%). Overall quality ranged from 4 to 7 (7 is the maximum score). Inconsistent recommendations were on prophylactic PLT transfusion in hypoproliferative thrombocytopenia in the presence of risk factors and dose recommendations. CONCLUSION Inconsistencies between guidelines and variable quality highlight areas for future guideline writers to address. Areas of specific attention include issues of stakeholder involvement and applicability.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine