小柯机器人

加拿大麦克马斯特大学Liang Yao团队对共识和循证指南中不一致和不适当的不一致建议进行了实证分析。相关论文发表在2021年11月25日出版的《英国医学杂志》上。

为了调查基于共识的指南与循证指南在建议强度与证据质量的一致性方面是否存在差异，研究组进行了一项实证分析。选择截至2021年3月27日，由美国心脏病学会/美国心脏协会（ACC/AHA）和美国临床肿瘤学会（ASCO）制定的指南。建议被明确归类为共识或循证，与文本的其余部分分开，并包括证据的质量和建议的强度。

数据提取配对作者独立提取推荐特征，包括推荐类型（共识或循证）、用于制定推荐的评分系统、推荐强度和证据质量。研究组还计算了不一致建议（证据质量低的强烈建议）和不恰当的不一致建议（不符合建议评估、发展和适当性评价标准的建议）的数量。

该研究共包括12项ACC/AHA指南，产生1434项建议；69项ASCO指南，产生1094项建议。在504项基于低质量证据的ACC/AHA建议中，200项（40%）被证明基于共识，而304项（60%）基于证据；在404项基于低质量证据的ASCO建议中，292项（72%）基于共识，112项（28%）基于证据。在ACC/AHA和ASCO指南中，共识方法产生了比循证方法更多的不一致建议（ACC/AHA优势比为2.1，ASCO为2.9）和不适当的不一致建议（优势比分别为2.6和5.1）。

研究结果表明，基于共识的指南比基于证据的指南产生更多违反循证医学原则的建议。确保证据质量与建议强度的适当一致是制定“可信”指南的关键。

附：英文原文

Title: Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis

Author: Liang Yao, Muhammad Muneeb Ahmed, Gordon H Guyatt, Peijing Yan, Xu Hui, Qi Wang, Kehu Yang, Jinhui Tian, Benjamin Djulbegovic

Issue&Volume: 2021/11/25

Abstract:

Objective To investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines.

Design Empirical analysis.

Data source Guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) and the American Society of Clinical Oncology (ASCO) up to 27 March 2021.

Study selection Recommendations were clearly categorised as consensus or evidence based, were separated from the remainder of the text, and included both the quality of evidence and the strength of the recommendations.

Data extraction Paired authors independently extracted the recommendation characteristics, including type of recommendation (consensus or evidence based), grading system used for developing recommendations, strength of the recommendation, and quality of evidence. The study team also calculated the number of discordant recommendations (strong recommendations with low quality evidence) and inappropriate discordant recommendations (those that did not meet grading of recommendations assessment, development, and evaluation criteria of appropriateness).

Results The study included 12 ACC/AHA guidelines that generated 1434 recommendations and 69 ASCO guidelines that generated 1094 recommendations. Of the 504 ACC/AHA recommendations based on low quality evidence, 200 (40%) proved to be consensus based versus 304 (60%) evidence based; of the 404 ASCO recommendations based on low quality evidence, 292 (72%) were consensus based versus 112 (28%) that were evidence based. In both ACC/AHA and ASCO guidelines, the consensus approach yielded more discordant recommendations (ACC/AHA: odds ratio 2.1, 95% confidence interval 1.5 to 3.1; ASCO: 2.9, 1.1 to 7.8) and inappropriate discordant recommendations (ACC/AHA: 2.6, 1.7 to 3.7; ASCO: 5.1, 1.6 to 16.0) than the evidence based approach.

Conclusion Consensus based guidelines produce more recommendations violating the evidence based medicine principles than evidence based guidelines. Ensuring appropriate alignment of quality of evidence with the strength of recommendations is key to the development of “trustworthy” guidelines.

DOI: 10.1136/bmj-2021-066045

Source: https://www.bmj.com/content/375/bmj-2021-066045

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj