Lost in Translation Between Evidence and Recommendations: Expert Opinion is Needed to Define “Level I”

Abstract

Abstract The aims of clinical practice guidelines (CPGs) are to provide clinicians with both a comprehensive review of the available evidence as well as to offer practical recommendations to reflect best patient care. Clinicians trust level I recommendations, issued on preponderantly solid randomized clinical trials (RCTs), to guide best practice decision-making. However, sometimes physicians following one CPG find themselves in the situation in which they do not follow another, issued on the same strong evidence base. Our aim is to reflect on the consistency of recommendations in different guidelines (between-guideline consistency).We also consider within-guideline consistency (or durability), defined as the amount of recommendations carried over from one edition to another in consecutive editions of the same CPG. For illustration purposes, we use two examples: hypertension guidelines and traumatic brain injury (TBI) guidelines. We conclude that just like research, CPGs also need to have between-guideline and within-guideline consistency (akin to reproducibility of studies). Clinicians and researchers should take into account the lower consistency of guidelines that are not based on at least one strong RCT.