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Clinical management guidelines

The BMJ asks reviewers to use this checklist, which is based on material published by three main sources - the US Agency for Health Care Policy and Research, the NHS Management Executive, and the North of England Guidelines Group:

Authors of papers presenting clinical management guidelines should ensure that:

  • patient population to which guidelines apply is clearly described
  • condition(s) to be detected, treated, or prevented is/are clearly defined
  • circumstances (clinical/non-clinical) in which exceptions might be made in using the guidelines are clearly described
  • methods for taking into account patient preferences in using the guidelines are clearly described
  • guidelines have been reviewed by independent experts or peers
  • guidelines have been piloted or pre-tested, with adequate discussion of how such results have been used
  • main topics covered by the guidelines are presented clearly, with an accurate summary
  • methods used to identify and select evidence are described clearly
  • sources of information used in developing guidelines are referenced adequately
  • methods used to assess strength of evidence are adequate and are described clearly
  • method used to synthesise evidence (eg for meta-analysis or decision analysis) are clearly described
  • methods used to reach expert or group consensus, and strength of consensus are clearly described
  • those who developed the guideline eg individuals, interest groups are described clearly and are appropriate eg sufficiently multidisciplinary
  • methods for taking into account potential biases/competing interests among guideline developers are clearly described and adequate
  • methods used to seek views of interested parties not on the panel are described
  • each major recommendation can be found easily
  • recommendations are consistent with each other
  • recommendations collectively cover all clinically relevant circumstances, or guideline explains why they do not
  • qualitative and quantitative information is given about the health benefits and potential harms/risks of recommendations eg additional life expectancy, quality adjusted life years
  • adequate qualitative and quantitative information is given about the costs of recommendations
  • other guidelines dealing with the same topic are mentioned, and differences discussed
  • levels or categories of evidence are expressed thus:
    • Ia evidence from meta-analysis of randomised controlled trials
    • Ib evidence from at least one randomised controlled trial
    • IIa evidence from at least one controlled study without randomisation
    • IIb evidence from at least one other type of quasi-experimental study
    • III evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case control studies
    • IV evidence from expert committee reports or opinions or clinical experience of respected authorities, or both
  • strength of recommendations is expressed thus:
    • A directly based on category I evidence
    • B directly based on category II evidence or extrapolated recommendation from category I evidence
    • C directly based on category III evidence or extrapolated recommendation from category I or II evidence
    • D directly based on category IV evidence or extrapolated recommendation from category I, II, or III evidence
  • date for scheduled review or expiry of the guidelines is given