Tuesday, 17 November 2009

Caution when using Guidelines

Interesting analysis especially considering the history of IDSA Lyme Disease Guidelines.

Below are just some of the extracts from the meeting found on Medscape


Medscape Conference Coverage, based on selected sessions at the:Infectious Diseases Society of America (IDSA) 47th Annual Meeting.

From Medscape Medical News

Infectious Disease Treatment Guidelines Weakened By Paucity of Scientific Evidence

Daniel M. Keller, PhD

November 13, 2009 (Philadelphia, Pennsylvania) — Two separate analyses presented here at the Infectious Diseases Society of America (IDSA) 47th Annual Meeting revealed that most of the society's treatment guidelines are based on expert opinion, nonrandomized trials, and case studies.

Between 1994 and April 2009, IDSA issued 68 guidelines on 52 different topics .

Dr. Lee summarized his presentation, saying that of the 1408 guideline recommendations he reviewed, "more than half were based on level III evidence, which is from expert opinion or not supported by properly controlled trials. Level I evidence was only 15%." He said his study should help to point out where evidence is lacking and to suggest areas for further research.

Physicians and trainees should not just look at guidelines, but should also examine the strength of the evidence on which they are based, he advised. "When clinicians are using the guidelines, they should not assume that they are all based on well-designed studies. . . . Clinicians should remain cautious when using current guidelines as the sole source for guiding patient care."

A second presentation supported the findings of Lee and coworkers. Abdur Khan, MD, assistant consultant at King Fahad Medical City in Riyadh, Saudi Arabia, presented his results in a poster session. Of the 65 IDSA guidelines, encompassing 6667 recommendations, issued between March 1994 and July 2009, he and his colleagues evaluated the 44, comprising 4206 recommendations, that were posted on the IDSA Web site at the end of July.

They, too, found that, overall, the strength of the recommendations did not correlate with the available evidence. Level I evidence was the basis for only 15% of the guidelines, which is in agreement with the findings that Lee and colleagues reported. Thirty percent of the evidence was level II."

Around 55% of the guidelines had a level of evidence of III, which was based on expert opinion," evel II; 37.8% on level III).

Neither of these studies received funding. Dr. Lee and Dr. Khan have disclosed no relevant financial relationships.

Infectious Diseases Society of America (IDSA) 47th Annual Meeting: Abstract 1324. presented November 1, 2009; Abstract LB-31, presented October 31, 2009.---------------------------------

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