A critical appraisal of chronic venous insufficiency ultrasound guidelines—Views of Australian sonographers

Background: Duplex ultrasound is the first line of investigation for patients seeking treatment for varicose veins disease. In Australia, chronic venous insufficiency ultrasound examinations (CVI-US) are primarily performed by sonographers. The use of clinical guidelines facilitates the practice of ultrasound, and more importantly, provides an assurance to the integrity and quality of the examinations. Our aim is to assess the quality of currently available guidelines and provide recommendations for choosing the appropriate guideline to use and suggestions for future guideline development. Method: We performed a systematic literature search of the Cochrane, EMBASE, EBSCO, Medline, PubMed, Google and the database of the University of Sydney. The scope covered guidelines from 2000 to 2020 available in English. Identified guidelines were appraised by four independent reviewers (sonographers) using the revised version of the Appraisal of Guidelines Research and Evaluation instrument. Results: A total of 10 guidelines were included for critical appraisal. Analysis of the results showed most guidelines were rated low quality except for the International Union of Phlebology consensus document (2006) and technical guideline by Zygmunt and colleagues (2020). Overall, Domain 1 (Scope and purposes) achieved the highest score (total score = 67.9% ± 17.3%), whereas, Domain 3 (Rigour of development) had the lowest score (total score = 41.1% ± 13.5%). Conclusion: The overall quality of CVI-US guidelines is poor. This study highlights the demand for developing ultrasound guidelines based on methodologically sound principles along with updated scientific evidence. A stronger emphasis should be given to clinical applicability in the Australian context.