Objectives:

To assess the current validity of 17 clinical practice guidelines developed under the auspices of the Agency for Health Care Policy and Research (AHCPR), now renamed the Agency for Healthcare Research and Quality (AHRQ)

Search strategy:

For each of the guideline topics, we conducted literature searches of MEDLINE^® and Embase, limited to articles designated as guidelines, editorials, or reviews, and further restricted for some topics to particular key general medical and specialty journals. Additionally, we conducted a survey of members of the original AHCPR guideline expert panel to identify new evidence relevant to the validity of the existing guideline statements.

Data Collection and Analysis:

Identified evidence was used to assess the current validity of individual practice guideline statements. These results were used to classify each guideline into one of the following categories:

Withdraw. New evidence called into question one or more key diagnostic or therapeutic recommendations, or new evidence suggested the need for new key diagnostic or therapeutic guideline recommendations.

Retain, append new evidence. All key diagnostic or therapeutic recommendations were still valid, but new evidence supported changes to other recommendations, or supported greater refinement of existing recommendations.

Retain. The guideline continued to represent good clinical care.

Main Results:

One hundred twenty-one of 170 (71%) surveys sent to experts were returned. Limited literature searches identified 6,994 titles, of which 181 potentially relevant articles were retrieved and reviewed. With the addition of evidence suggested by the experts, we reviewed 208 articles. Based on these data, seven guidelines were judged to be sufficiently obsolete as to warrant withdrawal (Depression in Primary Care vols. 1 & 2, Cataract in Adults, Sickle Cell Disease, Benign Prostatic Hyperplasia, Unstable Angina, Heart Failure, and Otitis Media with Effusion), three guidelines were judged to be still valid and retained (Pressure Ulcers in Adults, Treatment of Pressure Ulcers, and Cardiac Rehabilitation), and six guidelines were judged to be worth retaining but relevant new information for clinicians needed to be appended (Acute Pain Management, Urinary Incontinence in Adults, Management of Cancer Pain, Acute Low Back Problems in Adults, Post-Stroke Rehabilitation, and Reco! gnition and Initial Assessment of Alzheimer's Disease and Related Dementias).

Conclusions:

Almost half of the existing AHRQ practice guidelines should be withdrawn, and an additional six guidelines should have additional information appended. Three guidelines are judged sufficiently valid to remain in circulation.