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

Jesper Brok ^1*, Gorm Greisen ², Lars P Madsen ³, Karen Tilma ⁴, Jan Faerk ⁵, Klaus Børch ⁶, Ester Garne ⁷, Henrik T Christensen ⁸, Hristo Stanchev ⁹, Thorkild Jacobsen ¹⁰, Jens P Nielsen ¹¹, Tine Brink Henriksen ¹² and Christian Gluud ¹

¹ The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Denmark
² Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark., Denmark
³ Department of Paediatrics, Aalborg Sygehus Nord, Denmark, Denmark
⁴ Department of Paediatrics, Vendsyssel Hospital, Hjørrring, Denmark., Denmark
⁵ Department of Paediatrics, Holbæk Hospital, Denmark, Denmark
⁶ Department of Paediatrics, Hvidovre Hospital, Denmark, Denmark
⁷ Department of Paediatrics, Kolding Hospital, Denmark, Denmark
⁸ Department of Paediatrics, Odense University Hospital, Denmark, Denmark
⁹ Department of Paediatrics, Naestved Hospital, Denmark, Denmark
¹⁰ Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark, Denmark
¹¹ Department of Paediatrics, Sygehus Viborg, Denmark, Estonia
¹² Perinatal Epidemiology Research Unit, Dept of Obstetrics and Paediatrics, Aarhus University Hospital, Denmark

^* To whom correspondence should be addressed. E-mail: jbrok{at}ctu.rh.dk.

Accepted 27 August 2007

Abstract

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

Design:Retrospective analysis of clinical guidelines for newborn infants.

Materials:All Cochrane neonatal reviews and Danish local clinical guidelines for newborn infants.

Main outcome measures:The recommendations from the Cochrane reviews and local neonatal guidelines were compared and classified as being in agreement, partial agreement, or disagreement. Guideline authors were asked whether Cochrane reviews had been considered during guideline development and reasons for disagreements. Heterogeneity among departments was assessed.

Results:173 interventions evaluated in Cochrane neonatal reviews were included. All 17 Danish neonatal departments agreed to participate, but only 14 (82%) delivered data. Agreement between reviews and guidelines was observed for a median of 132 interventions (76%) (range 129 to 134), partial agreement for 31 interventions (18%) (range 29 to 33), and disagreement for 10 interventions (6%) (range 8 to 13) (Kappa = 0.56, range 0.53 to 0.59). Most of the latter 10 interventions were not recommended in the reviews but in the guidelines. The reasons for disagreement were numerous; usage of evidence with higher bias risks than randomised trials in guidelines development was the most frequent one. Cochrane reviews were rarely (10%) used during guideline development. Nine guideline topics (5%) revealed diversity among the departments’ recommendations.

Conclusions:There is good agreement between Cochrane reviews and neonatal guidelines in Denmark. The disagreements are few. Cochrane reviews were rarely used for guideline development. Guideline heterogeneity among neonatal departments seems moderate.

Keywords: Cochrane reviews, clinical pratice guidelines, evidence-based medicine, meta-analyses, neonatology

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