Ackman M L, Druteika D, Tsuyuki R T
University of Alberta Hospital, Edmonton, Canada.
Can J Cardiol. 2000 Oct;16(10):1249-54.
Clinical practice guidelines (CPGs) can be helpful in distilling the medical research literature for clinicians; however, the guidelines should acknowledge the variable methodological quality used in clinical research by tempering their recommendations with a 'levels of evidence' scale.
To evaluate the proportion of English-language cardiovascular CPGs that provide the user with recommendations graded according to a defined levels of evidence scale. In addition, to evaluate other key aspects important in the critical appraisal of CPGs.
CPGs for atrial fibrillation, congestive heart failure and myocardial infarction were identified by searching MEDLINE, a reference text of CPGs and the Internet. Each CPG was evaluated using a priori-defined criteria based on the Evidence-Based Medicine Working Group's paper on critical appraisal of CPGs, including use of a reproducible search strategy, method of obtaining consensus, peer review and testing in practice.
A total of 95 CPGs were evaluated. Only 13% graded their recommendations using a defined levels of evidence scale. In addition, few CPGs documented a reproducible search strategy or peer review process, and none had been formally tested in practice.
Reporting the levels of evidence for recommendations is an important component of CPGs, yet this system is not widely used.
临床实践指南（CPGs）有助于为临床医生提炼医学研究文献；然而，这些指南应通过用“证据级别”量表来调整其建议，以承认临床研究中所使用的方法学质量存在差异。
评估为用户提供根据已定义的证据级别量表分级的建议的英文心血管CPGs的比例。此外，评估在CPGs的批判性评价中重要的其他关键方面。
通过检索MEDLINE、CPGs参考文献及互联网来识别房颤、充血性心力衰竭和心肌梗死的CPGs。每个CPG使用基于循证医学工作组关于CPGs批判性评价的论文预先定义的标准进行评估，包括使用可重复的检索策略、达成共识的方法、同行评审及实践检验。
共评估了95个CPGs。只有13%使用已定义的证据级别量表对其建议进行分级。此外，很少有CPGs记录了可重复的检索策略或同行评审过程，且没有一个在实践中进行过正式检验。
报告建议的证据级别是CPGs的一个重要组成部分，但该系统尚未得到广泛应用。
