ArticleBMJ (Clinical research ed.)2021
Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis.
Article in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
What it found
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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
27 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Blood pressure targets for hypertension in people with chronic renal disease.The Cochrane database of systematic reviews · 2024Pooled it
- Comprehensive consideration of multiple determinants from evidence to recommendations in guidelines for most traditional Chinese medicine was suboptimal: a systematic review.BMC complementary medicine and therapies · 2024Pooled it
- Pooled it
- Association of the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) Scores with Guideline Recommendations in Breast Cancer.Current oncology (Toronto, Ont.) · 2026Article
- When Strong Recommendations Rest on Weak Evidence: Lessons From Therapeutic Apheresis Guidelines.Journal of clinical apheresis · 2026Article
- Optimizing Intermittent Catheterization Following Spinal Cord Injury: A Narrative Review Using the WHO Health System Building Blocks Framework.Advances in urology · 2026Review
- Inadequacies in uveitis: misnomers, incongruencies, persistence of obsolete terminologies & inappropriate guidelines, treatment inadequacies, and misinterpretations.Journal of ophthalmic inflammation and infection · 2025Review
- Article
- Analysis of European Association of Urology Guidelines 2023 and its adherence to GRADE methodology.Clinical and public health guidelines · 2024Article
- Panel stacking is a threat to consensus statement validity.Journal of clinical epidemiology · 2024Article
- Decision theoretical foundations of clinical practice guidelines: an extension of the ASH thrombophilia guidelines.Blood advances · 2024Article
- Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach.BMJ open · 2024Article
- Distinguishing ASH clinical practice guidelines from other forms of ASH clinical advice.Blood advances · 2024Article
- Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study.Journal of personalized medicine · 2023Article
- Cross-sectional analysis of pharmaceutical payments to Japanese board-certified gastroenterologists between 2016 and 2019.BMJ open · 2023Article
- Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines.BMC medical research methodology · 2023Article
- Article
- Discordant recommendations: when strong recommendations are based on low certainty evidence.Archives of dermatological research · 2023Article
- Professional medical education approaches: mobilizing evidence for clinicians.Frontiers in medicine · 2023Review
- Guidelines, guidelines and more guidelines for haemorrhoid treatment: A review to sort the wheat from the chaff.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
objectiveTo investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines.
designEmpirical 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).
resultsThe 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.
conclusionConsensus 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.
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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.