An evaluation of the eCOVID19 Recommendation Map identified diverging Clinical and Public Health guidance

Authors	NASIR Z. H. MERTZ D. NIEUWLAAT R. SANTESSO N. LOTFI T. MOTILALL A. MOJA L. MBUAGBAW L. KLUGAR Miloslav TURGEON A. F. MATHEW J. L. CANELO-AYBAR C. POTTIE K. DEWIDAR O. LANGENDAM M. W. IORIO A. VIST G. E. MEERPOHL J. J. FLOTTORP S. KREDO T. PIGGOTT T. MATHEWS M. QASEEM A. CHU D. K. TUGWELL P. KLUGAROVÁ Jitka NELSON H. HUSSEIN H. SUVADA J. NEUMANN I. SCHÜNEMANN H. J.
Year of publication	2022
Type	Article in Periodical
Magazine / Source	Journal of Clinical Epidemiology
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S0895435622000695
Doi	http://dx.doi.org/10.1016/j.jclinepi.2022.03.008
Keywords	COVID-19; Divergence; Discordance; GRADE; Guidelines; Recommendations
Description	Objective To describe divergence between actionable statements issued by COVID-19 guideline developers catalogued on the “COVID-19 Recommendations and Gateway to Contextualization” platform. Study Design and Setting We defined divergence as at least two comparable actionable statements with different explicit judgements of strength, direction or subgroup consideration of the population or intervention. We applied content analysis to compare guideline development methods for a sample of diverging statements and to evaluate factors associated with divergence. Results Of the 138 guidelines evaluated, 85 (62%) contained at least one statement that diverged from another guideline. We identified 223 diverging statements in these 85 guidelines. We grouped statements into 66 clusters. Each cluster addressed the same population, intervention, and comparator group or just similar interventions. Clinical practice statements were more likely to diverge in explicit judgment of strength or direction compared to public health statements (Cramer’s V = 0.7, Fisher’s exact test; P <0.001). Statements were more likely to diverge in strength than direction. Date of publication, utilized evidence, interpretation of evidence, and contextualization considerations were associated with divergence. Conclusion More than half of the assessed guidelines issued at least one diverging statement. This study helps understanding the types of differences between guidelines issuing comparable statements and factors associated with their divergence.