Abstract
Guidelines often use the term expert opinion (EO) to qualify recommendations. We sought to identify the rationale and evidence type in EO recommendations. We searched multiple databases and websites for contemporary guidelines published in the last decade that used the term EO. We identified 1106 references, of which 69 guidelines were included (2390 recommendations, of which 907 were qualified as EO). A rationale for using EO designation was not provided in most (91%) recommendations. The most commonly cited evidence type was extrapolated from studies that did not answer guideline question (40% from randomised trials, 38% from observational studies and 2% from case reports or series). Evidence extrapolated from populations that were different from those addressed in the guideline was found in 2.5% of EO recommendations. We judged 5.6% of EO recommendations as ones that could have been potentially labelled as good practice statements. None of the EO recommendations were explicitly described as being solely dependent on the clinical experience of the panel. The use of EO as a level of evidence in guidelines remains common. A rationale for such use is not explicitly provided in most instances. Most of the time, evidence labelled as EO was indirect evidence and occasionally was very low-quality evidence derived from case series. We posit that the explicit description of evidence type, as opposed to using the label EO, may add clarity and transparency and may ultimately improve uptake of recommendations.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 164-169 |
| Number of pages | 6 |
| Journal | Evidence-Based Medicine |
| Volume | 22 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 1 2017 |
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Keywords
- Epidemiology
Cite this
What does expert opinion in guidelines mean? a meta-epidemiological study. / Ponce, Oscar J.; Alvarez-Villalobos, Neri; Shah, Raj; Mohammed, Khaled; Morgan, Rebecca L.; Sultan, Shahnaz; Falck-Ytter, Yngve; Prokop, Larry J.; Dahm, Philipp; Mustafa, Reem A.; Murad, Mohammad H.
In: Evidence-Based Medicine, Vol. 22, No. 5, 01.10.2017, p. 164-169.Research output: Contribution to journal › Article
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TY - JOUR
T1 - What does expert opinion in guidelines mean? a meta-epidemiological study
AU - Ponce, Oscar J.
AU - Alvarez-Villalobos, Neri
AU - Shah, Raj
AU - Mohammed, Khaled
AU - Morgan, Rebecca L.
AU - Sultan, Shahnaz
AU - Falck-Ytter, Yngve
AU - Prokop, Larry J.
AU - Dahm, Philipp
AU - Mustafa, Reem A.
AU - Murad, Mohammad H.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Guidelines often use the term expert opinion (EO) to qualify recommendations. We sought to identify the rationale and evidence type in EO recommendations. We searched multiple databases and websites for contemporary guidelines published in the last decade that used the term EO. We identified 1106 references, of which 69 guidelines were included (2390 recommendations, of which 907 were qualified as EO). A rationale for using EO designation was not provided in most (91%) recommendations. The most commonly cited evidence type was extrapolated from studies that did not answer guideline question (40% from randomised trials, 38% from observational studies and 2% from case reports or series). Evidence extrapolated from populations that were different from those addressed in the guideline was found in 2.5% of EO recommendations. We judged 5.6% of EO recommendations as ones that could have been potentially labelled as good practice statements. None of the EO recommendations were explicitly described as being solely dependent on the clinical experience of the panel. The use of EO as a level of evidence in guidelines remains common. A rationale for such use is not explicitly provided in most instances. Most of the time, evidence labelled as EO was indirect evidence and occasionally was very low-quality evidence derived from case series. We posit that the explicit description of evidence type, as opposed to using the label EO, may add clarity and transparency and may ultimately improve uptake of recommendations.
AB - Guidelines often use the term expert opinion (EO) to qualify recommendations. We sought to identify the rationale and evidence type in EO recommendations. We searched multiple databases and websites for contemporary guidelines published in the last decade that used the term EO. We identified 1106 references, of which 69 guidelines were included (2390 recommendations, of which 907 were qualified as EO). A rationale for using EO designation was not provided in most (91%) recommendations. The most commonly cited evidence type was extrapolated from studies that did not answer guideline question (40% from randomised trials, 38% from observational studies and 2% from case reports or series). Evidence extrapolated from populations that were different from those addressed in the guideline was found in 2.5% of EO recommendations. We judged 5.6% of EO recommendations as ones that could have been potentially labelled as good practice statements. None of the EO recommendations were explicitly described as being solely dependent on the clinical experience of the panel. The use of EO as a level of evidence in guidelines remains common. A rationale for such use is not explicitly provided in most instances. Most of the time, evidence labelled as EO was indirect evidence and occasionally was very low-quality evidence derived from case series. We posit that the explicit description of evidence type, as opposed to using the label EO, may add clarity and transparency and may ultimately improve uptake of recommendations.
KW - Epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85030633115&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030633115&partnerID=8YFLogxK
U2 - 10.1136/ebmed-2017-110798
DO - 10.1136/ebmed-2017-110798
M3 - Article
C2 - 28924055
AN - SCOPUS:85030633115
VL - 22
SP - 164
EP - 169
JO - Evidence-Based Medicine
JF - Evidence-Based Medicine
SN - 1356-5524
IS - 5
ER -