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Review
. 2013 Dec;58(6):2142-52.
doi: 10.1002/hep.26578. Epub 2013 Oct 18.

AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations

Christopher Koh  1 , Xiongce Zhao, Niharika Samala, Sasan Sakiani, T Jake Liang, Jayant A Talwalkar
Affiliations
Review

AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations

Christopher Koh et al. Hepatology. 2013 Dec.

Abstract

The American Association for the Study of Liver Diseases (AASLD) practice guidelines provide recommendations in diagnosing and managing patients with liver disease from available scientific evidence in combination with expert consensus opinions. The aim was to systematically review the evolution of recommendations from AASLD guidelines and identify gaps limiting the evidence-based foundations of these guidelines. Initial and current AASLD guidelines published from January 1998 to August 2012 were reviewed. The AGREE II instrument was used to evaluate rigor and transparency of guideline development. The number of recommendations, distribution of grades (strength or certainty), classes (benefit versus risk), and types of recommendations were evaluated. Whenever possible, multiple versions were evaluated for evolving scientific evidence. A total of 991 recommendations from 28 guidelines on 17 topics were evaluated. From initial to current guidelines, the total number of recommendations increased by 36% (512 to 699). The largest increases were from chronic hepatitis B virus (HBV) (+71), liver transplantation (+53), and autoimmune hepatitis (AIH) (+27). Most current recommendations are grade II (44%) and less than 20% are grade I. The AGREE II evaluation showed global improvement in guideline quality. Both HBV and chronic hepatitis C guidelines had greatest increases in grade I recommendations (+383% and +67%, respectively). The greatest increases in treatment recommendations were from HBV (grade I, +1,150%), liver transplantation (grade II, +112%), and AIH (grade III, +105%).

Conclusion: Despite significant increases in the numbers of recommendations within AASLD practice guidelines over time, only a minority are supported by grade I evidence, highlighting the need for developing well-designed investigations to provide evidence for areas of uncertainty and improving the quality of future guidelines in hepatobiliary diseases.

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References

    1. Field M, Lohr K. Guidelines for Clinical Practice: From Development to Use. Washington, DC: National Academy Press; 1992. - PubMed
    1. Guidelines International Network. [Accessed January 31, 2012];International Guidelines Library. 2012 from http://www.g-i-n.net/library/international-guidelines-library.
    1. Agency for Healthcare Research and Quality. [Accessed January 1, 2012];National Guidelines Clearinghouse. 2012 from http://www.guideline.gov/browse/index.aspx?alpha=A. (2012, at http://www.g-i-n.net/library/international-guidelines-library.)
    1. Institute of Medicine of the National Academies. [Accessed January 31, 2012];Clinical Practice Guidelines We Can Trust, Consensus Report. 2011 from http://iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.
    1. Bancos I, Cheng T, Prokop LJ, Montori VM, Murad MH. Endocrine clinical practice guidelines in North America. A systematic assessment of quality. Journal of clinical epidemiology. 2012 - PubMed

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