ArticleJournal of general internal medicine2026
Level of Evidence and Strength of Recommendations in US Medical Society Clinical Practice Guidelines, 2019-2023: A Cross-Sectional Analysis.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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
1 citing paper in PubMed.
- Economic and Resource Use-Related Guidance in US Medical Societies' Clinical Practice Guidelines.JAMA network open · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundClinicians rely on medical societies' clinical practice guidelines to inform evidence-based patient care. Concordance between these guidelines' strength of recommendation (SOR) ratings and corresponding level of evidence (LOE) ratings is unclear.
objectiveEvaluate concordance between SOR and LOE ratings for guideline recommendations.
designCross-sectional analysis. RESEARCH SUBJECTS: Recommendations from 309 clinical practice guideline documents issued by 23 US-based medical societies from 2019 to 2023. MAIN MEASURES: Recommendation-level variables: SOR and LOE ratings. Society-level variables: methodology for assigning SOR and LOE ratings and society's specialty type. SOR-LOE ratings were concordant if the LOE rating was at least as strong as the SOR rating, with concordance quantified using modified Cohen's kappa [κ]. KEY
resultsAmong 7582 recommendations, society guideline writing committees rated SOR as strong for 2303 (30%) recommendations, moderate for 1351 (18%), weak for 2028 (27%), and 1900 recommendations (25%) had no strength assigned. Regarding LOE ratings, 768 (10%) recommendations had strong evidence, 1676 (22%) had moderate evidence, 2421 (32%) had weak or very weak evidence, and 2717 (36%) had evidence lacking an LOE rating. Overall, 5088 (67.1%) recommendations had SOR-LOE rating concordance, and overall SOR-LOE rating concordance was moderate (κ = 0.67; 95% confidence interval (CI) 0.66-0.68). Strong recommendations, however, had minimal SOR-LOE concordance (κ = 0.27; 95% CI 0.25-0.28; p < 0.001), with 1690 (73%) having LOE ratings weaker than strong. Recommendations based on a Modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework (κ = 0.33; 95% CI 0.30-0.37, p < 0.001), and issued by obstetrics/gynecology (κ = 0.46; 95% CI 0.40-0.51, p < 0.001) or neurology/psychiatry (κ = 0.22; 95% CI 0.18-0.26, p < 0.001) societies had significantly lower rating concordance.
conclusionsAmong recently issued CPG recommendations, overall SOR-LOE rating concordance was moderate, although recommendations with strong SOR ratings had minimal rating concordance. CPG authors could provide clearer rationales for strong recommendations when the corresponding evidence does not reflect commensurate certainty.
Indexed as
Identifiers
What OpenQuestion holds
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.