Systematic reviews supporting practice guideline recommendations lack protection against bias

• Published in: Journal of clinical epidemiology Vol. 66; no. 6; pp. 633 - 638
• Main Authors: Brito, Juan P, Tsapas, Apostolos, Griebeler, Marcio L, Wang, Zhen, Prutsky, Gabriela J, Domecq, Juan Pablo, Murad, M. Hassan, Montori, Victor M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2013; Elsevier; Elsevier Limited
• Subjects: AMSTAR; Bias; Biological and medical sciences; Clinical medicine; Clinical practice guidelines; Clinical Protocols - standards; Clinical trials; Endocrinology; Endocrinology - standards; Epidemiology; Evidence-Based Medicine; Humans; Internal Medicine; Medical sciences; Miscellaneous; Observational studies; Practice Guidelines as Topic; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality; Quality standards; Research Design - standards; Review Literature as Topic; Standard deviation; Studies; Systematic reviews; Systematic reviews; Clinical practice guidelines; AMSTAR; Quality; Endocrinology; Professional practice; Evidence-based practice; Systematic review; Evidence-based medicine; Protection; Recommendation; Bibliographic review
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2013.01.008

Abstract Objective To evaluate the quality of systematic reviews (SRs) affecting clinical practice in endocrinology. Study Design and Setting We identified all SRs cited in The Endocrine Society's Clinical Practice Guidelines published between 2006 and January 2012. We evaluated the methodological and reporting quality of the SRs in duplicate using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. We also noted if the guidelines recommendations that are clearly supported by SRs acknowledged their quality. Results During the 5-year period of study, endocrine guidelines cited 69 SRs. These SRs had a mean AMSTAR score of 6.4 (standard deviation, 2.5) of a maximum score of 11, with scores improving over time. SRs of randomized trials had higher AMSTAR scores than those of observational studies. Low-quality SRs (methodological AMSTAR score 1 or 2 of 5, n  = 24, 35%) were cited in 24 different recommendations and were the main evidentiary support for five recommendations, of which only one acknowledged the quality of SRs. Conclusion Few recommendations in endocrinology are supported by SRs. The quality of SRs is suboptimal and is not acknowledged by guideline developers.