Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy.
<h4>Introduction</h4>Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of...
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Public Library of Science (PLoS)
2017-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0178456 |
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| author | Arjun K Venkatesh Dan Savage Benjamin Sandefur Kenneth R Bernard Craig Rothenberg Jeremiah D Schuur |
| author_facet | Arjun K Venkatesh Dan Savage Benjamin Sandefur Kenneth R Bernard Craig Rothenberg Jeremiah D Schuur |
| author_sort | Arjun K Venkatesh |
| collection | DOAJ |
| description | <h4>Introduction</h4>Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence.<h4>Methods</h4>Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies.<h4>Results</h4>A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent.<h4>Conclusions</h4>Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality standards. |
| format | Article |
| id | doaj-art-92fd4de8ae6b43c6840b7e9385ae67b3 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-92fd4de8ae6b43c6840b7e9385ae67b32025-08-20T03:24:02ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01126e017845610.1371/journal.pone.0178456Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy.Arjun K VenkateshDan SavageBenjamin SandefurKenneth R BernardCraig RothenbergJeremiah D Schuur<h4>Introduction</h4>Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence.<h4>Methods</h4>Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies.<h4>Results</h4>A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent.<h4>Conclusions</h4>Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality standards.https://doi.org/10.1371/journal.pone.0178456 |
| spellingShingle | Arjun K Venkatesh Dan Savage Benjamin Sandefur Kenneth R Bernard Craig Rothenberg Jeremiah D Schuur Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. PLoS ONE |
| title | Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. |
| title_full | Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. |
| title_fullStr | Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. |
| title_full_unstemmed | Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. |
| title_short | Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. |
| title_sort | systematic review of emergency medicine clinical practice guidelines implications for research and policy |
| url | https://doi.org/10.1371/journal.pone.0178456 |
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