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Table 3 Reviewers’ comments on the four CPGs organized according to the standardized domains in AGREE II 22–25*

From: Quality assessment of evidence-based clinical practice guidelines for the management of pregnant women with sickle cell disease using the AGREE II instrument: a systematic review

AGREE II Domain Strengths Limitations
Domain 1. Scope and purpose • Objectives, purpose, health intent, clinical questions, and patient population were clearly mentioned in the CPG full document or the website using the PICO model (NICE, NHLBI, RCOG). • Target users were general rather than specific (ACOG)
Domain 2. Stakeholder Involvement • GDG members’ names, specialties, institutions, and geographical locations were clearly mentioned and easy to find. GDG included methodologist(s) (NICE, RCOG).
• GDG included members from relevant professional groups including patient representatives (NICE).
• GDG disciplines and roles were not clearly mentioned (ACOG).
• GDG was missing some key disciplines (e.g. pharmacists and nurses) (RCOG).
• Lack of adequate and clear descriptions of patient participation or preferences and target users (ACOG, NHLBI).
Domain 3. Rigor of development • Detailed evidence search keywords were mentioned (NICE, RCOG).
• The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of evidence was utilized (NICE, NHLBI).
• Recommendations include health benefits, harms, and side effects of recommendations with or without a discussion of their trade-offs (NICE, NHLBI).
• All recommendations were linked to their relevant primary source of evidence (NICE, NHLBI, RCOG).
• Lists and processes of external review were clearly reported and easy to find (NICE, NHLBI, RCOG).
• Updating was clearly mentioned (NICE, RCOG).
• Lack of detailed search strategy (ACOG).
• Strengths and limitations of the body of evidence (evidence tables) were not clearly reported (ACOG).
• Lack of detailed process for formulation of the recommendations, and discussion of a trade-off between harms and benefits (ACOG, RCOG).
• Details and methods of the external review process and outcomes were not clearly reported (ACOG).
• Review and update process was not reported (ACOG, NHLBI).
Domain 4. Clarity and presentation • This domain was well-addressed in most included CPGs, where key recommendations were specific, unambiguous, and easily identifiable in all CPGs (NICE, NHLBI, RCOG). • Management of SCD Crisis in different pregnancy trimesters and abnormal fetal surveillance management were not highlighted (ACOG).
Domain 5. Applicability • Some facilitators and barriers to implementations and clinical governance issues were discussed (NHLBI, NICE, RCOG).
• A package of CPG Implementation tools was provided like educational tools (NICE), protocols (NHLBI), summary document (NHLBI, NICE, RCOG), patient information (NHLBI, NICE), clinical algorithm or pathway (NHLBI, NICE), baseline assessment sheet (NICE), Mobile App (RCOG).
• Quality standards, measures, indicators, and/ or clinical audit criteria were provided (NICE, RCOG).
• A formal economic analysis was conducted (NICE).
• Facilitators and barriers to implementations were not explicitly mentioned (ACOG).
• Implementation tools were not provided (ACOG).
• Quality measures or key performance indicators were not provided (ACOG, NHLBI).
• No formal economic analysis was conducted (ACOG, NHLBI, and RCOG).
Domain 6. Editorial independence • Funding with or without an influence statement was mentioned (NICE, NHLBI, RCOG).
• DCOI statements were clearly provided (NICE, NHLBI, RCOG).
• Funding and influence statements were not clearly reported (ACOG, NHLBI).
• No DCOI statements were provided (ACOG).
  1. Abbreviations: ACOG American College of Obstetricians and Gynecologists; AGREE II Appraisal of Guidelines for Research and Evaluation II; CPG clinical practice guideline or guidance; DCOI declaration of conflict of interests; NICE National Institute of Health and Care Excellence; NHLBI National Institutes of Health, National Heart, Lung, and Blood Institute; PICO patient population -intervention(s)-comparison(s)-outcome(s); and RCOG Royal College of Obstetricians and Gynaecologists. *Comments specific to certain CPG(s) were indicated by parentheses