Checklist for appraising clinical management guidelines

The LJPC asks reviewers to use this checklist, which is based on material published by three main sources - the US Agency for Health Care Policy and Research, the NHS Management Executive, and the North of England Guidelines Group:

Authors of papers presenting clinical management guidelines should ensure that:

• patient population to which guidelines apply is clearly described
• condition(s) to be detected, treated, or prevented is/are clearly defined
• circumstances (clinical/non-clinical) in which exceptions might be made in using the guidelines are clearly described
• methods for taking into account patient preferences in using the guidelines are clearly described
• guidelines have been reviewed by independent experts or peers
• guidelines have been piloted or pre-tested, with adequate discussion of how such results have been used
• main topics covered by the guidelines are presented clearly, with an accurate summary
• methods used to identify and select evidence are described clearly
• sources of information used in developing guidelines are referenced adequately
• methods used to assess strength of evidence are adequate and are described clearly
• method used to synthesise evidence (eg for meta-analysis or decision analysis) are clearly described
• methods used to reach expert or group consensus, and strength of consensus are clearly described
• those who developed the guideline eg individuals, interest groups are described clearly and are appropriate eg sufficiently multidisciplinary
• methods for taking into account potential biases/competing interests among guideline developers are clearly described and adequate
• methods used to seek views of interested parties not on the panel are described
• each major recommendation can be found easily
• recommendations are consistent with each other
• recommendations collectively cover all clinically relevant circumstances, or guideline explains why they do not
• qualitative and quantitative information is given about the health benefits and potential harms/risks of recommendations eg additional life expectancy, quality adjusted life years
• adequate qualitative and quantitative information is given about the costs of recommendations
• other guidelines dealing with the same topic are mentioned, and differences discussed
• levels or categories of evidence are expressed thus:
1. evidence from meta-analysis of randomised controlled trials
2. evidence from at least one randomised controlled trial
3. evidence from at least one controlled study without randomisation
4. evidence from at least one other type of quasi-experimental study
5. evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case control studies
6. evidence from expert committee reports or opinions or clinical experience of respected authorities, or both
• strength of recommendations is expressed thus:
1. directly based on category I evidence
2. directly based on category II evidence or extrapolated recommendation from category I or II evidence
3. directly based on category III evidence or extrapolated recommendation from category I, II or III evidence
4. directly based on category IV evidence or extrapolated recommendation from category I, II, III or IV evidence
• date for scheduled review or expiry of the guidelines is given