Clinical practice guidelines for the treatment of Covid-19 in Brazil: A systematic review
DOI:
https://doi.org/10.15649/cuidarte.2025Keywords:
Coronavirus Infections, Pandemics, Systematic Review, Guidelines as Topic, TherapeuticsAbstract
Introduction: Coronavirus disease (Covid-19) is an infectious disease affecting the respiratory tract, which emerged in China and spread rapidly throughout the world. Objective: To evaluate the methodological quality and transparency of Brazilian clinical practice guidelines for the treatment of coronavirus disease (Covid-19). Materials and Methods: A systematic review was conducted in 2020 on Medline (via PubMed), Embase, Scopus, LILACS, National Guideline Clearinghouse and Guidelines International Network databases, in addition to online searches on the Brazilian Ministry of Health, Brazilian Medical Association, Federal Council of Medicine, Federal Council of Nursing and Federal Council of Physical Therapy websites. The methodological quality and transparency of the guidelines were assessed using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument developed by four authors. Results: 33 guidelines were found of which 14 were included in the analysis. There was only one guideline that scored above 60% in all domains. Among the six domains, higher scores were found in the following three domains: scope and objective, stakeholder involvement and clarity of presentation. Discussion: Despite methodological weakness found, the authors were keen to provide clear and concise recommendations through key information and therapeutic options to facilitate decision making. Conclusions: Brazilian clinical practice guidelines were found to be of poor methodological quality, from which only one guideline was recommended and classified as to be of high methodological quality and transparency.
How to cite this article: Lanes, Taís Carpes; Ribeiro, Mariane Albuquerque Lima; Oliveira, Daianny Seoni de; Junior, Marcos Gabriel do Nascimento; Garcia, Filipe Reis; Melo, Jéssyca Maria França de Oliveira; Tiguman, Gustavo Magno Baldin. Diretrizes de prática clínica para o tratamento da Covid-19 no Brasil: uma revisão sistemática. Revista Cuidarte. 2021;12(2):e2025 http://dx.doi.org/10.15649/cuidarte.2025
References
Stasi C, Fallani S, Voller F, Silvestri C. Treatment for Covid-19: An overview. 2020;889. https://doi-org.ez47.periodicos.capes.gov.br/10.1016/j.ejphar.2020.173644
França EB, Ishitani LH, Teixeira RA, Abreu DMX, Corrêa PRL, Marinho F, et al. Deaths due to Covid-19 in Brazil: how many are there and which are being identified? Rev Bras Epidemiol. 2020;23:E200053. https://doi.org/10.1590/1980-549720200053
Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS et al. Coronavirus disease 2019 –COVID-19. Clin Microbiol Rev. 2020;33:e00028-20. https://doi.org/10 .1128/CMR.00028-20
Dagens A, Sigfrid L, Cai E, Lipworth S, Cheung V, Harris E, Bannister P, et al. Scope, quality, and inclusivity of clinical guidelines produced early in the Covid-19 pandemic: rapid review. BMJ 2020;369:m1936. https://doi.org/10.1136/bmj.m1936
Song Y, Liu Q, Ren J, Yang W, Qiu K, Qiu J, et al. Quality Guidelines for Corona Virus Disease 2019 with AGREE II Instrument. Authorea. 2020;1–7. https://doi.org/10.22541/au.158817475.57911772
Birken AS, Ellis SD, Walker JS, DiMartino LD, Check DK, Gerstel AA et al. Guidelines for the use of survivorship care plans: A systematic quality appraisal using the AGREE II instrument. Implementation Science. 2015;10(1):63. https://doi.org/10.1186/s13012-015-0254-9
Li Y, Li J, Zhong D, Zhang Y, Zhang Y, Guo Y et al. Clinical practice guidelines and experts’ consensuses of traditional Chinese herbal medicine for novel coronavirus (Covid-19): Protocol of a systematic review. Systematic Reviews. 2020;9(1):1–5. https://doi.org/10.1186/s13643-020-01432-4
Sanjeeve S, Patel V, Nijjer SS, Kirresh A, Darzi A, Chambers JC et al. Guidelines in cardiac clinical practice: Evaluation of their methodological quality using the AGREE II instrument. Journal of the Royal Society of Medicine. 2013;106(8):315–22. https://doi.org/10.1177/0141076813486261
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with Covid-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–62, 2020. https://doi.org/10.1016/S0140-6736(20)30566-3
Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma G. Preferred reporting items for sys - tematic reviews and meta-analyses: the Prisma Statement (Reprinted from Annals of Internal Medicine). Phys Ther 2009;89:873-80.
AGREE Next Steps Consortium (2009). The AGREE II Instrument [versão eletrônica]. Available from: http://www.agreetrust.org.
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE Next Steps Consortium. Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ. 2010;182(10):E472-8. http://dx.doi.org/10.1503/cmaj.091716
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reportingand evaluation in health care. CMAJ. 2010;182(18): E839 – E842. http://dx.doi.org/10.1503/cmaj.090449
Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33(3):613-9. http://dx.doi.org/10.1177/001316447303300309
Brosseau L, Rahman P, Toupin-April K, Poitras S, King J, Angelis G, et al. A Systematic Critical Appraisal for Non-Pharmacological Management of Osteoarthritis Using the Appraisal of Guidelines Research and Evaluation II Instrument PLoS One. 2014;9(1): e82986. https://doi.org/10.1371/journal.pone.0082986
Yan J, Min J, Zhou B. Diagnosis of pheochromocytoma: a clinical practice guideline appraisal using AGREE II instrument. J Clin Pract Eval. 2013;19(4):626 -32. https://doi.org/10.1111/j.1365-2753.2012.01873.x
Brasil. Ministério da saúde. Secretaria de Atenção Primária à Saúde (SAPS). Protocolo de manejo clínico do coronavírus (Covid-19) na Atenção Primária à Saúde: versão 8. Brasília – DF, abril de 2020.
Brasil. Ministério da Saúde. Secretaria de Atenção Especializada à Saúde. Departamento de Atenção Hospitalar, Domiciliar e de Urgência. Protocolo de Manejo Clínico da Covid-19 na Atenção Especializada. 1. ed. rev. Brasília-DF: 48p., 2020.
Brasil. Ministério da saúde. Secretaria de Ciência, Tecnologia, Inovação e
Insumos Estratégicos em Saúde – SCTIE. Diretrizes para diagnóstico e tratamento da Covid-19. Versão 3. Brasília – DF, 2020.
Associação Médica Brasileira (AMB). Diretrizes AMB: COVID – 19. São Paulo. 2020.
Guimarães HP, Schubert DUC, Rodrigues RR, Freitas APR, Corrêa TD, Cunha KA, et al. Recomendações sobre Oxigenioterapia no Departamento de Emergência para Pacientes Suspeitos ou Confirmados de Covid-19. Associação Brasileira de Medicina de Emergência (ABRAMEDE). Versão 2. Porto Alegre, abril de 2020.
Gasperini L, Stédile MO, Santos MN, Mello MCR, Moraes VM, Margoti FH, et al. Recomendações para o atendimento de pacientes suspeitos ou confirmados de Covid-19 pelos fisioterapeutas no departamento de Emergência. Associação Brasileira de Medicina de Emergência (ABRAMEDE). Departamento de Fisioterapia da Associação Brasileira de Medicina de Emergência. 2020.
Santos MN, Endres LF, Marinho RC, Medeiros RM, Margoti FH, Silva MPS, et al. Recomendações para o atendimento de pacientes suspeitos ou confirmados Covid-19, pelas equipes de enfermagem de serviços de emergência (pré-hospitalar fixo e intra-hospitalar). Associação Brasileira de Medicina de Emergência (ABRAMEDE). 2020.
Guimarães HP, Damasceno MC, Ribera JM, Onimaru A, Malvestio M, Bueno M. Recomendações para o atendimento de pacientes suspeitos ou confirmados de infecção pelo novo coronavírus (SARS-COV-2) pelas equipes de atendimento pré-hospitalar móvel. Associação Brasileira de Medicina de Emergência (ABRAMEDE). Abril/2020.
Brasil. Ministério da Saúde. Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCoV). Brasília – DF, 2020.
Associação de Medicina Intensiva Brasileira (AMIB). Orientações sobre o manuseio do paciente com pneumonia e insuficiência respiratória devido a infecção pelo coronavírus (SARS-CoV-2). Versão 5. São Paulo, 2020.
Grupo força colaborativa Covid-19 Brasil. Orientações sobre Diagnóstico, Tratamento e Isolamento de Pacientes com Covid-19. Versão 01. São Paulo. Abril de 2020.
Falavigna M, Colpani V, Stein C, Azevedo LCP, Bagattini AM, Brito GV, et al. Diretrizes para o Tratamento Farmacológico da COVID-19. Associação de Medicina Intensiva Brasileira (AMIB). Maio/2020.
Lago P, Santana JC, Hendler J, Foschiera L, Silva AP, Biondo G, et al. Recomendações para Atendimentos de Casos Suspeitos de Covid-19 em Emergências Pediátricas Associação Brasileira de Medicina de Emergência (ABRAMEDE). 2020.
Guimarães HP, Schubert DUC, Rodrigues RR, Freitas APR, Corrêa TD, Cunha KA, et al. Recomendações para Intubação Orotraqueal em pacientes portadores de Covid-19. Associação Brasileira de Medicina de Emergência (ABRAMEDE) e Associação de Medicina Intensiva Brasileira (AMIB). Versão 2. Abril/2020.
Falavigna M, Colpani V, Stein C, Azevedo LCP, Bagattini AM, Brito GVde et al. Diretrizes para o tratamento farmacológico da Covid-19. Consenso da Associação de Medicina Intensiva Brasileira, da Sociedade Brasileira de Infectologia e da Sociedade Brasileira de Pneumologia e Tisiologia. Rev. bras. ter. intensiva. 2020;32(2):166-196. https://doi.org/10.5935/0103-507x.20200039
Sousa DMN, Lima ACMACC, Vasconcelos CTM, Stein AT, Oriá MOB. Development of a clinical protocol for detection of cervical cancer precursor lesions. Rev. Latino-Am. Enfermagem. 2018;26:e2999. http://dx.doi.org/10.1590/1518-8345.2340.2999
Shang Y, Pan C, Yang X, Zhong M, Shang X, Wu Z, et al. Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Annals of Intensive Care. 2020;10(73). http://dx.doi.org/10.1186/s13613-020-00689-1
Jomah S, Asdaq SMB, Al-Yamani MJ. Clinical efficacy of antivirals against novel coronavirus (Covid-19): A review. J Infect Public Health. 2020;13(9):1187-1195. https://doi.org/10.1016/j.jiph.2020.07.013
Oliveira MAP, Parente RCM. Understanding Randomized Controlled Trials. Brazilian Journal of Videoendoscopic Surgery. 2010;3(4):176-180.
Aroni P, Furuya RK, Dantas RAS, Galvão CM. Ensaio clínico randomizado: aspectos conceituais e metodológicos. In: Lacerca MB, Ribeiro RP, Costenaro RGS (org.). Metodologias das pesquisas para a enfermagem e saúde. 1.ed. Porto Alegre: Moriá, 2018:55-60.
Daneshfar M, Dadashzadeh N, Ahmadpour M, Ragati Haghi H, Rahmani V, Forouzesh M, et al. Lessons of mortality following Covid-19 epidemic in the United States especially in the geriatrics. J Nephropharmacol. 2021;10(1):e06. https://doi.org/10.34172/npj.2021.06
Papagiannis D, Malli F, Raptis DG, Papathanasiou IV, Fradelos EC, Daniil Z, et al. Assessment of Knowledge, Attitudes, and Practices towards New Coronavirus (SARS-CoV-2) of Health Care Professionals in Greece before the Outbreak Period. Int J Environ Res Public Health. 2020;17(14):4925. https://doi.org/10.3390/ijerph17144925
Hoffmann-Esser W, Siering U, Neugebauer EAM, Brockhaus AC, McGauran N, Eikermann M. Guideline appraisal with AGREE II: online survey of the potential influence of AGREE II items on overall assessment of guideline quality and recommendation for use. BMC Health Serv Res. 2018;18(1):143. https://doi.org/10.1186/s12913-018-2954-8.
Arieta-Miranda J, Alcaychahua AS, Santos GP, Sevillano MC, Verástegui RL, Victorio DB, et al. Quality assessment of clinical practice guidelines for the management of paediatric dental emergencies applicable to the COVID-19 pandemic, using the AGREE II instrument. A systematic Review. Heliyon. 2020;6:e05612. https://doi.org/10.1016/j.heliyon.2020.e05612
Jiao XF, Li HL, Cheng L, Zhang C, Yang CS, Han J, et al. Methodological quality of clinical practice guidelines for genetic testing in children: a systematic assessment using the appraisal of guidelines for research and evaluation II instrument. Med. (United States). 2019;98(52). https://doi.org/10.1097 / MD.0000000000018521
Published
How to Cite
Altmetrics
Downloads
License
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.
