The Need to Systematically Evaluate Clinical Practice Guidelines

Article Figures & Data

Table 1.

Examples of Harm Associated with Guidelines

Guideline	Harmful Effect
American Thoracic Society guidelines for the treatment of pneumonia.⁹	Prescribing consistent with guidelines had a trend toward higher mortality and subsequent hospitalization.¹⁰
European Society of Cardiology guidelines for anticoagulant treatment of atrial fibrillation.¹¹	Recommendation by this group result in a 3-fold higher rate of hemorrhage compared with guidelines from the American College of Chest Physicians.¹²
Guidelines from Australia, Canada, China, Europe, France, Japan, South Africa, United Kingdom, and United States recommending thrombolytic treatment from 3 to 4.5 hours after the onset of acute ischemic stroke.	Administering the thrombolytic alteplase 3 to 4.5 hours after the onset of stroke increases mortality 2%, without evidence of benefit.¹³
Draft guidelines on the use of electrodiagnostic testing for patients with low-back pain.	Given clinical vignettes, physicians increased ordering of tests when given specific guidance recommending against their use compared with physicians given nonspecific guidelines also recommending against routine use of the tests.¹⁴