Background:Clinical guidelines (CGs) need to be updated to ensure the ongoing validity of recommendations. Aims and objectives:This systematic review identified and described the most recent CG update processes, including prioritisation methods, used by international or national groups who provide methodological guidance for developing and updating CGs. Methods:Methodological handbooks were identified by searching a predefined list of national and international organisations, and by grey literature searching. A systematic literature search (2011–2021) of Medline, Embase and the Cochrane Library was conducted to identify peer-reviewed articles that described the development and or evaluation of update processes. Data were extracted by one reviewer and checked by a second. Quality assessment was conducted independently by two reviewers. A narrative synthesis was undertaken. Findings:In total, 16 handbooks from 11 organisations and three peer-reviewed articles were included. Few handbooks provided comprehensive details beyond whether an update was indicated, with processes for prioritisation of updates and required resources generally lacking; terminology and definitions differed across organisations. In general, evidence synthesis methods used to update CGs were the same as those used to develop CGs de novo. Discussion and conclusion:Updating CGs is critical to support policy and practice. It is an iterative process that is both resource-intensive and time-consuming. International or national groups who provide methodological guidance for developing and updating CGs should consider providing more comprehensive guidance and standardising the terminology used to facilitate optimal updating of CGs and prioritisation of CGs for updating.

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