Agreement between Cochrane Neonatal reviews and clinical practice guidelines for newborns in Denmark: a cross-sectional study

doi:10.1136/adc.2007.118000

ORIGINAL ARTICLES

Agreement between Cochrane Neonatal reviews and clinical practice guidelines for newborns in Denmark: a cross-sectional study

J Brok¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, G Greisen¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, L P Madsen¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, K Tilma¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, J Faerk¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, K Børch¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, E Garne¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, H T Christesen¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, H Stanchev¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, T Jacobsen¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, J P Nielsen¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, T B Henriksen¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11, C Gluud¹^,2^,3^,4^,5^,6^,7^,8^,9^,10^,11

¹ Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
² Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
³ Department of Paediatrics, Aalborg Sygehus Nord, Denmark
⁴ Department of Paediatrics, Vendsyssel Hospital, Hjørrring, Denmark
⁵ Department of Paediatrics, Holbæk Hospital, Holbæk, Denmark
⁶ Department of Paediatrics, Hvidovre Hospital, Hvidovre, Denmark
⁷ Department of Paediatrics, Kolding Hospital, Kolding, Denmark
⁸ Department of Paediatrics, Odense University Hospital, Odense, Denmark
⁹ Department of Paediatrics, Naestved Hospital, Naestved, Denmark
¹⁰ Department of Paediatrics, Sygehus Viborg, Denmark
¹¹ Perinatal Epidemiology Research Unit, Departments of Obstetrics and Paediatrics, Aarhus University Hospital, Skejby, Denmark

Correspondence to:
J Brok, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; jbrok{at}ctu.rh.dk

Objective: To assess agreement between Cochrane Neonatal Group reviewsand clinical practice guidelines in Denmark.

Design: Retrospective analysis of clinical guidelines for newborn infants.

Materials: All Cochrane neonatal reviews and Danish clinical guidelinesfor newborn infants.

Main outcome measures: The recommendations from the Cochrane reviews and local clinicalguidelines were compared and classified as being in agreement,in partial agreement or in disagreement. Authors of guidelineswere asked whether Cochrane reviews had been considered duringguideline development and reasons for any disagreements. Heterogeneityamong departments was assessed.

Results: 173 interventions evaluated in Cochrane neonatal reviews wereincluded. All 17 Danish neonatal departments agreed to participate,but only 14 (82%) delivered data. Agreement between reviewsand guidelines was observed for a median of 132 interventions(76%) (range 129–134), partial agreement was observedfor 31 interventions (18%) (range 29–33), and disagreementwas observed for 10 interventions (6%) (range 8–13) ( ${kappa}$ = 0.56, range 0.53–0.59). Most of the latter 10 interventionswere not recommended in the reviews but were recommended inthe guidelines. There were numerous reasons for disagreement,the most common being usage of evidence with higher bias risksthan randomised trials in guidelines development. Overall, Cochranereviews were rarely (10%) used during guideline development.For nine guideline topics (5%) there was diversity among theDanish departments’ recommendations.

Conclusions: There is good agreement between Cochrane reviews and neonatalguidelines in Denmark. However, Cochrane reviews were rarelyused for guideline development. Heterogeneity among guidelinesproduced by the various neonatal departments seems moderate.