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February 2009
Renal Transplants for Children: Guidelines
What are the indications for renal transplants for children? Perhaps a good place to look for the answer would be in practice guidelines. We have several places to look for these, including professionals and nonprofit society web pages. However, both the National Guideline Clearinghouse (NGC) and PubMed offer quick and easy ways to find them. Then, of course, we must satisfy ourselves that these guidelines are based on evidence rather than expert opinion.
The NGC website states that it "is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ)." Let's start there.
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As we have written before about keyword searching, let's look at another and perhaps more precise way of finding guidelines: category browsing. On the left navigation bar of the home page, you can find a "Browse" box that allows you to search by disease/condition, treatment, organization, and more. Clicking through these hierarchies can quickly lead to relevant guidelines.
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As we are interested in transplantation, we choose "Treatment/Intervention," and drill down.
This allows us to quickly identify an appropriate guideline, and check for the evidence on which it is based. Sometimes this is available quickly, by checking the "evidence summary" section.
Other times, we must dig a little deeper, checking the "Methodology" in the complete summary.
An added advantage to NGC is its notation of what particular recommendations within the guidelines are based on expert opinion, and which are based on the evidence.
However, all guidelines are not in NGC, and so we turn to PubMed. Using the proper Medical Subject Heading (MeSH) will make our search more precise. As always, when we want information about care for children, we use the limits for children. And because we want guidelines, we can choose the publication limits for "practice guidelines."
This search brings back six citations, the most promising of which is:
This article seems to contain the information we need. As its publication type is both "practice guideline" and "review" we assume it was based on a survey of the literature. As with all articles, we must read this one with a critical eye to the methodology of the literature review as well as the strength of the evidence articles on which the recommendations are based.
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