The validity of recommendations from clinical guidelines: a survival analysis

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 Our aim was to estimate the length of time before recommendations become outdated.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 re commendations 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 Interpretation:Recommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years.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. Abstract

Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review

“…This process is important, as it is aimed at improving implementability, by ensuring the recommendations are comprehensive, adaptable and applicable to the target group and have an open process [53]. Given the constant changing nature of evidence, having up-to-date guidelines certainly makes a difference to the validity [32]. However, the lowest rated item was for the guideline update procedures.…”

“…This search was limited from 2009 to search date, such that we would only capture CPGs developed within the past 5 years; given the evidence that CPGs may become out of date after only 3 years [32]. All languages were included in this search.…”

The current state of epilepsy guidelines: A systematic review

“…A recent analysis of the recommendations found in the Spanish National Health System CPGs developed since 2008 revealed that >20% of recommendations made in these CPGs became outdated within 3 years, and that number increases to 22.2% within 4 years. 27 Based on these findings, it is recommended that CPGs be updated at least every 3 years. 27 By these criteria, 71.43% of existing CPGs for persons with epilepsy can be considered at risk of being outdated.…”

“…27 Based on these findings, it is recommended that CPGs be updated at least every 3 years. 27 By these criteria, 71.43% of existing CPGs for persons with epilepsy can be considered at risk of being outdated. This also depends, however, on the specific field and topic addressed by a guideline.…”

Management of acne: Canadian clinical practice guideline

“…44 Updates may be provided sooner to include important new developments, such as evidence on benefits and harms of existing interventions, development of new treatments or changes in available treatments.…”