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. 2014 Nov 4;186(16):1211-9.
doi: 10.1503/cmaj.140547. Epub 2014 Sep 8.

The validity of recommendations from clinical guidelines: a survival analysis

Laura Martínez García  1 , Andrea Juliana Sanabria  2 , Elvira García Alvarez  2 , Maria Mar Trujillo-Martín  2 , Itziar Etxeandia-Ikobaltzeta  2 , Anna Kotzeva  2 , David Rigau  2 , Arturo Louro-González  2 , Leticia Barajas-Nava  2 , Petra Díaz Del Campo  2 , Maria-Dolors Estrada  2 , Ivan Solà  2 , Javier Gracia  2 , Flavia Salcedo-Fernandez  2 , Jennifer Lawson  2 , R Brian Haynes  2 , Pablo Alonso-Coello  2 ; Updating Guidelines Working Group
Collaborators, Affiliations

The validity of recommendations from clinical guidelines: a survival analysis

Laura Martínez García et al. CMAJ. .

Erratum in

Abstract

Background: Clinical guidelines should be updated to maintain their validity. Our aim was to estimate the length of time before recommendations become outdated.

Methods: We used a retrospective cohort design and included recommendations from clinical guidelines developed in the Spanish National Health System clinical guideline program since 2008. We performed a descriptive analysis of references, recommendations and resources used, and a survival analysis of recommendations using the Kaplan-Meier method.

Results: We included 113 recommendations from 4 clinical guidelines with a median of 4 years since the most recent search (range 3.9-4.4 yr). We retrieved 39 136 references (range 3343-14 787) using an exhaustive literature search, 668 of which were related to the recommendations in our sample. We identified 69 (10.3%) key references, corresponding to 25 (22.1%) recommendations that required updating. Ninety-two percent (95% confidence interval 86.9-97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%).

Interpretation: Recommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years. Waiting more than 3 years to review a guideline is potentially too long.

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Figures

Figure 1:
Figure 1:
Strategy to assess the validity of recommendations.
Figure 2:
Figure 2:
Kaplan–Meier survival curve (solid line) of clinical guideline recommendations with 95% confidence intervals (dashed lines).
See this image and copyright information in PMC

References

    1. Institute of Medicine. Clinical practice guideline we can trust. Washington (DC): The National Academies Press; 2011.
    1. Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med 2007;147:224–33. - PubMed
    1. Banzi R, Cinquini M, Liberati A, et al. Speed of updating online evidence based point of care summaries: prospective cohort analysis. BMJ 2011;343:d5856. - PMC - PubMed
    1. Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA 2001;286:1461–7. - PubMed
    1. Vernooij RWM, Sanabria AJ, Solà I, et al. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks. Implement Sci 2014;9:3. - PMC - PubMed

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