Expert Opinion

We received replies from the panel chair(s) for sixteen of the seventeen clinical practice guidelines. One panel chair did not respond to our contacts despite several attempts. A second panel chair responded that he had just completed an update of the guideline in question and did not respond further to our attempts at gaining additional information. For the remaining fifteen clinical practice guidelines, we received input from the panel chair(s) about which of their respective panel members should be contacted to assess the current validity of their practice guideline statements. For one of the two practice guidelines for which we did not receive this information, we contacted the Evidence-based Practice Center that had participated in the literature review for the "guideline update" process, and asked the lead member of the task order team to complete the survey concerning validity. For the remaining clinical practice guideline, we used information from one of the membe! rs of the guideline development team to determine which statements to send to which experts.

A few of the panel chairs also responded to our question about which disciplines possibly should have been represented on their panel but were not. These are listed by guideline in Table 6. The resources available for this project did not permit us to identify and seek input from experts in these disciplines regarding the current validity of the guidelines.

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Table 6. Relevant Clinical Disciplines not Represented on the Original Panel as listed by the expert panel chairs.

We then sent out the individual guideline statements to their respective experts. We were unable to attain current contact information for some of the recommended experts, and in a few instances the panelists were deceased. In total, we surveyed 175 experts. Five surveys were returned with the notation that the panelist was no longer at the given address and no forwarding address was known. Four panelists declined to participate in the survey. Of the remaining 170 outstanding surveys 121 (71%) were returned. The number of responses varied by guideline. Table 7 lists the number of surveys sent and the number returned by guideline. For all but three guidelines more than 60% of the surveys were returned.

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Table 7. Distribution and Response Rates of Guideline Documents.

We were also able to obtain assessments of the validity of the practice guideline statement from 8 non-panel experts for 7 of the guidelines. We contacted outside experts for the remaining guidelines, but we received no response and the time and resources available for this project did not allow us to continue to pursue outside input.

Table 8 reports the collated results of the responses to the two questions regarding the presence of new evidence sufficient to invalidate an existing guideline statement and whether any new guideline statements should be present. Most practice guideline statements were judged to be still valid. Practice guidelines statements concerning therapeutics were more likely to have been judged invalid than were statements concerning other aspects of diagnosis or management.

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Table 8. Results of Assessment of Validity.

Limited Literature Searches

Table 9 lists the number of titles identified in the limited literature searches by guideline. Table 10 lists the number of abstracts and articles reviewed by guideline. We retrieved 5,860 titles during our initial search, which focused on review articles and editorials. We identified 1,232 titles when our search was focused on key specialty journals and journals of major general interest. Overall, we reviewed a total of 6,994 titles. From these titles, 610 were selected for further review based on their potential for providing new information relating to the respective guideline areas. Abstracts were obtained and reviewed for all 610 of these titles. From these, 173 full-text articles were retrieved and reviewed by our physician reviewers. In addition, 159 guidelines were also retrieved and reviewed.

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Table 9. Titles Identified in the Limited Literature Searches Listed by Guideline.

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Table 10. Number of Abstracts and Articles Reviewed Listed by Guideline.

With the addition of evidence suggested by the experts, we reviewed 766 abstracts and 208 articles.