article · Archives of Disease in Childhood
An international evaluation examined the methodological quality of hospital-specific clinical practice guidelines for paediatric sepsis management across hospital sites on five continents. Fourteen guidelines from thirteen countries were reviewed using the AGREE II appraisal tool and compared against the Surviving Sepsis Campaign 2020 international reference standard across twelve key treatment recommendations. All examined guidelines were rated as having low methodological quality overall, scoring lowest in developmental rigour and editorial independence. Despite these methodological limitations, alignment with the international standard varied between 42% and 100%. The highest consistency between guidelines appeared in time-critical management steps, including time to antibiotic administration, initial laboratory investigations, and fluid bolus volume. Significant clinical variations were observed in steroid indications and fluid resuscitation composition.
Paediatric sepsis requires swift and reliable clinical intervention to prevent severe harm or death. Knowing that local hospital protocols frequently lack methodological rigour, despite adhering to standard timelines for antibiotics and fluids, highlights an urgent need for healthcare systems to standardise guidance on steroid use and fluid choice to ensure consistent care globally.
The abstract does not indicate an application pathway or commercialisation potential, as it focuses entirely on appraising the methodological quality and consistency of existing hospital clinical practice guidelines.
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Objectives To evaluate the methodological quality of hospital-specific paediatric sepsis clinical practice guidelines (CPGs) from sites participating in an international study using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to assess the consistency of treatment recommendations and concordance with the Surviving Sepsis Campaign 2020 (SSC 2020) international reference standard. Design Cross-sectional appraisal of hospital-specific CPGs. Setting Hospital sites participating in the Sepsis Epidemiology in Paediatric Acute Care International Study across five continents. Participants Hospital-specific CPGs for the acute care management of paediatric sepsis. Interventions Hospital-specific CPGs were appraised independently using the AGREE II tool and classified as high, moderate or low quality. Consistency across guidelines and concordance with SSC 2020 were assessed for 12 key treatment recommendations. Main outcome measures AGREE II domain scores and overall quality rating; consistency of treatment recommendations across hospital-specific CPGs; concordance of individual CPGs with SSC 2020. Results 14 hospital-specific CPGs from 13 countries were included. All were rated as low methodological quality overall; the rigour of development (range: 0–50%) and editorial independence (0–58%) were the lowest scoring AGREE II domains. CPG concordance with SSC 2020 ranged from 42% to 100%; consistency across the 12 treatment recommendations ranged from 43% (steroid indications) to 93% (initial laboratory investigations, time to antibiotics and fluid bolus volume). Conclusions Despite all hospital-specific CPGs across an international cohort being of low methodological quality, most aligned with SSC 2020 for key time-critical recommendations. Clinically important variations existed in fluid resuscitation composition and timing of steroid administration. Trial registration number ACTRN12621000920097.
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DOI: 10.1136/archdischild-2026-330907
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