Evaluating the quality of Canadian pediatric sepsis clinical practice guidelines.

objectivesSepsis is a common and clinically challenging life-threatening condition affecting children. Well-designed guidelines integrated into quality improvement initiatives reduce pediatric sepsis mortality and hospital length of stay. Our objective was to evaluate the quality of Canadian pediatric sepsis guidelines for children presenting to emergency departments (ED) and evaluate their consistency and concordance with the Surviving Sepsis guidelines (international reference standard).

methodsWe contacted all 15 Canadian pediatric hospitals and national organizations to obtain guidelines. Guidelines were included if they contained at least one recommendation on detection or management of pediatric sepsis in the ED. Two independent reviewers applied the AGREE-II tool to evaluate guideline quality (methodologic rigor). Quality was classified as high, moderate, or low based on published definitions. For each of the 12 ED-relevant recommendations from the reference standard, we calculated the percentage of all Canadian guidelines that provided the same recommendation (consistency). For each individual Canadian guideline, we calculated the percentage of the 12 recommendations that were the same as the reference standard (concordance).

resultsNine guidelines were included. Guidelines were presented as pathway/algorithm, order set, narrative, or a combination of formats. Most institutional guidelines were of low quality, and a single national guideline was classified as high quality. Overall, guidelines were highly consistent across most recommendations of the reference standard, except for fluid bolus content (balanced vs normal saline). Similarly, individual guidelines were highly concordant with the reference standard, with only one low-quality guideline having a concordance of less than 80%.

conclusionThe quality of Canadian institutional guidelines is low in terms of methodological development; however, recommendations in these guidelines remain generally consistent with an international reference standard, though key areas of inconsistency exist. Future efforts should focus on regularly reviewing and updating the robust national guideline that can be adapted to local institutional needs.