Variation in recommendations for management of pediatric fever and neutropenia across databases and languages: A systematic review of clinical practice guidelines.
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BACKGROUND: Fever with neutropenia (FN) is a common complication of cancer therapy associated with significant morbidity, mortality, and resource use. Clinicians currently may access multiple Clinical Practice Guidelines (CPG) for FN in children to guide decision-making, however variation in content could impact care globally. We performed a systematic review and content analysis of CPG to assess the impact of databases searched and publication language on the quantity, quality, and content of recommendations identified for pediatric FN. METHODS: We conducted a systematic search of PubMed, Embase, and Web of Science databases to identify evidence-based CPG published in the last 10 years addressing FN in children. We categorized CPG by language, extracted recommendations, characterized recommendation type (diagnostic, prognostic, or treatment), direction, and agreement with a recently developed international guideline. Methodological quality was assessed using the AGREE-II instrument and comparison between English and non-English CPG was performed using the Mann-Whitney U test. Comparisons of recommendation type (treatment, prognosis, diagnosis) and agreement with a reference guideline were assessed using the Chi-square test. RESULTS: Fourteen CPG met inclusion criteria. Ten were published in English and four in non-English languages. There was no significant difference in methodological quality between language categories across AGREE-II domains except for scope and purpose (95.2% versus 90.5%; p = 0.036). Each database contained one unique guideline and only 36% (5/14) of the CPG were indexed in three databases. Percentage agreement between recommendations covered by 14 CPG and the reference CPG ranged between 33% and 100%. CONCLUSIONS: Using pediatric FN as an index topic, we found that language or database restrictions limit the quantity and content of recommendations. Since CPG have variable methodological quality regardless of source, clinicians should design appropriate search strategies based on context. We recommend a broad search strategy when healthcare context or disease prevalence differs across settings.