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 |