AAN guidelines

Abstract

American Academy of Neurology (AAN) members assign high value to clinical practice guidelines. In a 2006 needs assessment survey, 82% of members rated guidelines as “important” or “very important.”1 Moreover, a 2009 survey of a representative sample of AAN members found that 75% used 1–6 AAN guidelines in the past year.2 However, the AAN has received feedback suggesting that guidelines without high-level recommendations (i.e., Level A or B) should not be published because they do not guide practice. Indeed, to account for lower levels of evidence, many specialty medical societies “fill in the gaps” with consensus and expert opinion–based recommendations. The AAN has decided not to incorporate consensus so as not to substitute the judgment of its members with the judgment of an expert panel, and maintains strict adherence to its evidence-based process. This decision was made with full knowledge that it may result in guidelines that are not as prescriptive for practice as many would find desirable. Such policy acknowledges that there are some questions that evidence-based medicine is ill-suited to answer and some important questions for which high-quality research is lacking. Nonetheless, the AAN′s guideline development subcommittees (Quality Standards Subcommittee [QSS] and Therapeutics and Technology Assessment Subcommittee [TTA]) believe that AAN guidelines are valuable tools regardless of the level of recommendation they contain. Our reasons for this belief follow. First, development of these documents involves performing a literature review for all evidence related to an answerable clinical question and grading it according to the AAN′s classification scheme.3 In view of the volume of literature available, a comprehensive but focused distillation of the evidence itself provides …