Evidence-based Medicine Toolkit

Critical appraisal of guidelines 23Methods3 Was there a comprehensive search for the evidence?The search for evidence should be as comprehensive as a systematicreview (see p. 29). Multiple databases should be used and keystakeholders should be identified for further information.4 Are the criteria for selecting and combining theevidence clearly described?There should be a clear and explicit statement of appropriate inclusionand exclusion criteria which were applied to the evidence.Guideline developers should consider all reasonable practice options,and all important potential outcomes. You should look forinformation on morbidity, mortality, and quality of life associatedwith each option.In examining cost-effectiveness outcomes, consider the perspectivethe developers have taken (see p. 70). This may influence finalrecommendations. It may be difficult for you to determine whethertheir cost estimates are valid or applicable for your practice setting.5 Are the methods used for formulating therecommendations clearly described?Guideline developers often deal with inadequate evidence; therefore,they may have to consider a variety of studies as well as reportsof expert and consumer experience.There must be clarity about the type and quantity of evidenceupon which each recommendation is based.Look for a report of methods used to synthesizepreferences from multiple sources.Informal and unstructured processes tojudge values may be susceptible to undueinfluence by individual panel members,particularly the panel chair. Appropriate,structured, processes, such as the Delphimethod (opposite) increase the likelihoodthat all important values are dulyconsidered.You should determine whether and howexpert opinion was used to fill in gaps inthe evidence.Problem area identifiedConstruct questionnaireAnalyse responsesHasconsensusemerged?NoTabulate responses andprovide furtherinformationRevised versionYes