Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul:135:125-135.
doi: 10.1016/j.jclinepi.2021.03.005. Epub 2021 Mar 7.

The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review

Tanja A Stamm  1 , Margaret R Andrews  2 , Erika Mosor  2 , Valentin Ritschl  2 , Linda C Li  3 , Jasmin K Ma  3 , Adalberto Campo-Arias  4 , Sarah Baker  5 , Nicola W Burton  6 , Mohammad Eghbali  7 , Natalia Fernandez  8 , Ricardo J O Ferreira  9 , Gabriele Gäbler  10 , Souzi Makri  11 , Sandra Mintz  12 , Rikke Helene Moe  13 , Elizabeth Morasso  14 , Susan L Murphy  8 , Simiso Ntuli  15 , Maisa Omara  16 , Miguel Angel Simancas-Pallares  17 , Jen Horonieff  18 , Gerald Gartlehner  19
Affiliations

The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review

Tanja A Stamm et al. J Clin Epidemiol. 2021 Jul.

Abstract

Objectives: The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19.

Study design and setting: Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting.

Results: There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline.

Conclusion: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

Keywords: COVID-19; Clinical practice guidelines; Coronavirus; Guidelines; Recommendations; SARS CoV-2.

PubMed Disclaimer

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
PRISMA chart.
Fig 2
Fig. 2
Country representation of the guideline authors. Absolute and relative frequencies per country are shown in Supplement Table G.
Fig 3
Fig. 3
Numbers of published guidelines which increased per week separately for each S-level Guidelines were classified according to the Association of the Scientific Medical Societies (AWMF) Guidance Manual and Rules for Guideline Development. S3 is a systematic literature review including a subsequent synthesis of the evidence and a structured consensus process completed by a representative committee. S2e refers to a systematic literature review and synthesis of the evidence only; S2k guidelines are based on a structured consensus process completed by a representative committee only. S2e and S2k are summarized in this graph as S2. S1 in this work includes both, documents based on an informal consensus process by a group of experts as well as expert opinions.
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J., et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–733. - PMC - PubMed
    1. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected—interim guidance. World Health Organization. Available at: https://www.who.int/publications-detail/clinical-management-of-severe-ac.... 2020. Accessed April 5, 2020.
    1. American Academy of Family Physicians (AAFP). Clinical practice guideline manual. Available at: https://www.aafp.org/patient-care/clinical-recommendations/cpg-manual.html. 2017. Accessed May 22, 2020.
    1. Institute of Medicine . In: Clinical practice guidelines we can trust. Graham R, Mancher M., editors. National Academies Press; Washington, DC: 2011. Committee on standards for developing trustworthy clinical practice guidelines. - PubMed
    1. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839–E842. - PMC - PubMed

Publication types