Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis.
Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis.
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DOI：
10.1136/bmj-2021-066045
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发表时间：
2021-11-25
期刊：
影响因子：
--
通讯作者：
Djulbegovic B
中科院分区：
文献类型：
--
作者：
Yao L;Ahmed MM;Guyatt GH;Yan P;Hui X;Wang Q;Yang K;Tian J;Djulbegovic B
调查在基于共识的指南与基于证据的指南中，建议强度与证据质量的一致性是否不同。实证分析。美国心脏病学会和美国心脏协会（ACC/AHA）以及美国临床肿瘤学会（ASCO）制定的指南，截止日期为2021年3月27日。建议被明确分类为共识或基于证据，与文本的其余部分分开，并包括证据的质量和建议的强度。配对作者独立提取推荐特征，包括推荐类型（共识或循证）、用于制定推荐的分级系统、推荐强度和证据质量。研究小组还计算了不一致建议（具有低质量证据的强烈建议）和不适当的不一致建议（不符合建议评估，开发和适当性评价标准的分级）的数量。该研究包括12个ACC/AHA指南，产生了1434条建议，69个ASCO指南，产生了1094条建议。在基于低质量证据的504项ACC/AHA建议中，200项（40%）被证明是基于共识的，304项（60%）是基于证据的;在基于低质量证据的404项ASCO建议中，292项（72%）是基于共识的，112项（28%）是基于证据的。在ACC/AHA和ASCO指南中，与循证方法相比，共识方法产生了更多的不一致建议（ACC/AHA：比值比2.1，95%置信区间1.5至3.1; ASCO：2.9，1.1至7.8）和不适当的不一致建议（ACC/AHA：2.6，1.7至3.7; ASCO：5.1，1.6至16.0）。基于共识的指南比基于证据的指南产生更多违反循证医学原则的建议。确保证据的质量与建议的力度适当一致是制定“值得信赖”的指南的关键。
To investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines. Empirical analysis. Guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) and the American Society of Clinical Oncology (ASCO) up to 27 March 2021. Recommendations were clearly categorised as consensus or evidence based, were separated from the remainder of the text, and included both the quality of evidence and the strength of the recommendations. Paired authors independently extracted the recommendation characteristics, including type of recommendation (consensus or evidence based), grading system used for developing recommendations, strength of the recommendation, and quality of evidence. The study team also calculated the number of discordant recommendations (strong recommendations with low quality evidence) and inappropriate discordant recommendations (those that did not meet grading of recommendations assessment, development, and evaluation criteria of appropriateness). The study included 12 ACC/AHA guidelines that generated 1434 recommendations and 69 ASCO guidelines that generated 1094 recommendations. Of the 504 ACC/AHA recommendations based on low quality evidence, 200 (40%) proved to be consensus based versus 304 (60%) evidence based; of the 404 ASCO recommendations based on low quality evidence, 292 (72%) were consensus based versus 112 (28%) that were evidence based. In both ACC/AHA and ASCO guidelines, the consensus approach yielded more discordant recommendations (ACC/AHA: odds ratio 2.1, 95% confidence interval 1.5 to 3.1; ASCO: 2.9, 1.1 to 7.8) and inappropriate discordant recommendations (ACC/AHA: 2.6, 1.7 to 3.7; ASCO: 5.1, 1.6 to 16.0) than the evidence based approach. Consensus based guidelines produce more recommendations violating the evidence based medicine principles than evidence based guidelines. Ensuring appropriate alignment of quality of evidence with the strength of recommendations is key to the development of “trustworthy” guidelines.
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影响因子：
11.8
作者：
Chapman, Stanley W.;Dismukes, William E.;Kauffman, Carol A.
通讯作者：
Kauffman, Carol A.
影响因子：
2.9
作者：
Agoritsas T;Merglen A;Heen AF;Kristiansen A;Neumann I;Brito JP;Brignardello-Petersen R;Alexander PE;Rind DM;Vandvik PO;Guyatt GH
通讯作者：
Guyatt GH
影响因子：
7.5
作者：
Bohlius, Julia;Bohlke, Kari;Lazo-Langner, Alejandro
通讯作者：
Lazo-Langner, Alejandro
影响因子：
7.2
作者：
Moerbeek, M;van Breukelen, GJP;Berger, MP
通讯作者：
Berger, MP
影响因子：
2.6
作者：
Lo, Sidney T. H.;Yong, Andy S.;Kritharides, Leonard
通讯作者：
Kritharides, Leonard