1. No category

Conflicts of Interest in Intensive Care
Guidelines: prevalence and contents.
Barea­Mendoza JA, Chico­Fernandez M, Viejo­Moreno R, Dominguez­Aguado H,
Terceros­Almanza L, Molina­Collado Z, Mudarra­Reche C. Intensive Care Department. Hospital Doce de Octubre. Madrid (Spain)
BACKGROUND
RESULTS
Many decisions in intensive care are based in
guidelines. However, in last years huge doubts about
how we develop our guidelines have emerged.
Important methodology issues have been developed
in published recommendations for authors. In this
way, one of the most important domain is assurance
the editorial independence.
Reporting and managing conflicts of interest (COI) or
funding of guidelines are core elements for
independence. In spite of this, recent literature
warning us about under-reporting conflict of Interest.
The aims of this paper is to describe current rates of
conflicts of interest and theirs content in intensive
care guidelines.
Ninety six guidelines fulfilled our search criteria. After reviewing abstracts were excluded
twenty-five because duplication. In extraction phase we excluded twenty (duplication, no
guidelines or no intensive care). Fifty-one guidelines and five hundred five authors were
eligible. (Figure 1. Flow Chart).
68,6% of guidelines (IC 95%: 55- 81%) report COI : 34 in original paper and one available
online. Twenty-five with COI available (71,4%) had a description about type of conflict with
wide variations. (Figure 2).
Figure 2: Guidelines who report Conflict of Interest. (%)
31,4
Reported
35 Guidelines (68,6% )
report.
No reported
25 of them have
description about COI.
68,6
METHODS
We searched in MEDLINE using MESH terms
(Intensive Care, Critical Care, Critical Illness) with a
specific filter for guidelines. We include all guidelines
between 12/12/2009 and 10/12/2014 related with
intensive care. No exclusion criteria. Guidelines were
revised to extract data about COI and funding.
Figure 3. By group, number of guidelines who reported. (n=51).
17
18
Yes
No
We sort guidelines according thematic
areas. The biggest group were
Metabolism and Nutrition guidelines
with 19 (37.5%).
16
14
12
(Figure 1. Flow Chart)
10
We explore the different rates of
reported COI in each group. Important
variability was observed with rates
between 28% (Infection and Sepsis) to
89.5% (Metabolism)
8
6
5
6
4
4
2
2
2
0
Other
Neurocritical care
Infection
Metabolism and nutrition
Hemodynamics
Organization
Among guidelines with report 156 authors of 338 (46%) had COI. 34% of guidelines had
less than 50% of their authors with COI; 100% of authors with COI in 54% of guidelines
who reported. Only six guidelines (12,2%) informed about funding of editorial process.
Figure 4: Porcentual distribution of guidelines according authors with COIs (%)
12
All authors have COI
Less than 50% of authors with COI
Other
54
34
CONCLUSION
Spite of recommendations an important amount of publications have no reports of COI nor
funding. More than half of authors have relevant COI in guidelines who reported.
Information about funding is poor.
Bindslev JBB, Schroll J, Gøtzsche PC, Lundh A. Underreporting of conflicts of interest in clinical practice guidelines: cross sectional study. BMC Med Ethics . 2013;14(19):1472–6939.
JA Barea-Mendoza
twitter: @jbaream
email: [email protected]
Intensive Care Department. Hospital Doce de Octubre. Madrid (Spain)
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