ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2014
The validity of recommendations from clinical guidelines: a survival analysis.
Erratum issuedAbstract read
In one paragraph
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 67 papers, 10 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 10 pooled it
–field-weighted citation impact
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
67 citing papers in PubMed, 10 syntheses or guidelines pooled it.
- Nutrition Recommendations for People Living After Cancer: A Systematic Review and Critical Appraisal of Clinical Practice Guidelines.Nutrients · 2026Pooled it
- Society of American Gastrointestinal and Endoscopic Surgeons guidelines development: Clinical Practice Guideline Update Standard Operating Procedure.Surgical endoscopy · 2025Guideline
- Nutrition management for patients with head and neck cancer during peri-radiotherapy: A systematic review and quality appraisal of clinical practice guidelines using the AGREE II instrument.Frontiers in oncology · 2022Pooled it
- Do stroke clinical practice guideline recommendations for the intervention of thickened liquids for aspiration support evidence based decision making? A systematic review and narrative synthesis.Journal of evaluation in clinical practice · 2020Pooled it
- Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.The Australian & New Zealand journal of obstetrics & gynaecology · 2020Guideline
- Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument.BMC health services research · 2020Pooled it
- "Knee osteoarthritis and current research for evidence-are we on the right way?"International orthopaedics · 2018Pooled it
- Guidelines for dementia or Parkinson's disease with depression or anxiety: a systematic review.BMC neurology · 2016Pooled it
- Management of acne: Canadian clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2016Guideline
- Pooled it
- Relevance of improved reporting for non-pharmacological interventions in clinical trials: Bridging research to clinical practice.Brazilian journal of physical therapy · 2026Review
- Adjunctive Pharmacotherapy for Major Depressive Disorder with Anxiety Symptoms: from Monoamines to Recent Clinical Evidence.CNS drugs · 2026Review
- Time for an Update: The Currency of Clinical Guidelines in Australia-A Cross-Sectional Analysis.The Medical journal of Australia · 2026Article
- Article
- Topical Prescription Therapy for Psoriasis: An Expert Position Paper on Limitations of Published Guidelines and Treatment Selection With Updated Recommendations.The Journal of clinical and aesthetic dermatology · 2026Review
- How consistent are recent neonatal resuscitation guidelines?Resuscitation plus · 2026Review
- A Computational Method for Systematic Comparison of Clinical Practice Guidelines.Clinical and public health guidelines · 2026Article
- Blood Activating and Stasis Removing Chinese Patent Medicine in Perioperative Period of Percutaneous Coronary Intervention for Myocardial Infarction: A Protocol for a Living Clinical Practice Guideline.Clinical and public health guidelines · 2026Article
- AES ILAE North America Symposium: Guiding Evidence-Based Epilepsy Management.Epilepsy currents · 2026Article
- Collaborative large language models (LLMs) are all you need for screening in systematic reviews.medRxiv : the preprint server for health sciences · 2026Article
7 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
18 authors.
Laura Martínez GarcíaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont. laura.martinez.garcia@cochrane.es.
Andrea Juliana SanabriaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Elvira García AlvarezIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Maria Mar Trujillo-MartínIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Itziar Etxeandia-IkobaltzetaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Anna KotzevaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
David RigauIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Arturo Louro-GonzálezIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Leticia Barajas-NavaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Petra Díaz Del CampoIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Maria-Dolors EstradaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Ivan SolàIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Javier GraciaIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Flavia Salcedo-FernandezIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Jennifer LawsonIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
R Brian HaynesIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Pablo Alonso-CoelloIberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
Updating Guidelines Working Group
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinical guidelines should be updated to maintain their validity. Our aim was to estimate the length of time before recommendations become outdated.
methodsWe used a retrospective cohort design and included recommendations from clinical guidelines developed in the Spanish National Health System clinical guideline program since 2008. We performed a descriptive analysis of references, recommendations and resources used, and a survival analysis of recommendations using the Kaplan-Meier method.
resultsWe included 113 recommendations from 4 clinical guidelines with a median of 4 years since the most recent search (range 3.9-4.4 yr). We retrieved 39 136 references (range 3343-14 787) using an exhaustive literature search, 668 of which were related to the recommendations in our sample. We identified 69 (10.3%) key references, corresponding to 25 (22.1%) recommendations that required updating. Ninety-two percent (95% confidence interval 86.9-97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%).
interpretationRecommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years. Waiting more than 3 years to review a guideline is potentially too long.
Indexed as
Diffusion of InnovationPractice Guidelines as TopicTranslational Research, BiomedicalCohort StudiesEvidence-Based MedicineGuideline AdherenceHumansReproducibility of ResultsRetrospective StudiesSpain
Identifiers
What OpenQuestion holds
Textmetadata
Read underepoch 390
Registered trials
None linked
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.