ArticlePLoS medicine2007
How evidence-based are the recommendations in evidence-based guidelines?
Article in PLoS medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 15 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 15 syntheses or guidelines pooled it.
- Clinical practice guidelines for acute kidney injury: a systematic review of the methodological quality.Frontiers in medicine · 2025Pooled it
- The impact of Cochrane Reviews that apply network meta-analysis in clinical guidelines: A systematic review.PloS one · 2024Pooled it
- Quality of Clinical Guidelines on Oral Care for Children with Special Healthcare Needs: A Systematic Review.International journal of environmental research and public health · 2023Pooled it
- Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review.Global heart · 2022Pooled it
- Pooled it
- Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Guideline
- Evaluation of guidelines regarding surgical treatment of breast cancer using the AGREE Instrument: a systematic review.BMJ open · 2017Pooled it
- Clinical practice guidelines for hypertension in China: a systematic review of the methodological quality.BMJ open · 2015Pooled it
- Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2014Guideline
- Vitamin intake reduce the risk of gastric cancer: meta-analysis and systematic review of randomized and observational studies.PloS one · 2014Pooled it
- Effects of screening for psychological distress on patient outcomes in cancer: a systematic review.Journal of psychosomatic research · 2013Pooled it
- Pooled it
- Critical appraisal of clinical practice guidelines for diagnosis and treatment of hepatocellular carcinoma.Journal of gastroenterology and hepatology · 2011Pooled it
- Pooled it
- The systematic guideline review: method, rationale, and test on chronic heart failure.BMC health services research · 2009Pooled it
- Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: exploratory analysis of a randomized trial.Annals of internal medicine · 2010 · on this mapTrial
- Systematic review of clinical guidance for lipid management in adults with or at risk of atherosclerotic cardiovascular disease: A global perspective.International journal of cardiology. Cardiovascular risk and prevention · 2026Review
- Article
- A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0.Journal of the American College of Emergency Physicians open · 2025Article
- RAPID: Reliable and efficient Automatic generation of submission rePortIng checklists with large language moDels.Journal of the American Medical Informatics Association : JAMIA · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTreatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT) evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability) underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND
findingsA cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension) from three pan-national guideline panels (from the United States, Canada, and Europe). Of the 338 treatment recommendations in these nine guidelines, 231 (68%) cited RCT evidence but only 105 (45%) of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51%) or because the RCT reported surrogate outcomes (59/126 cases, 47%).
conclusionsThe results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.