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Adherence of clinical practice guidelines for pharmacologic treatments of hospitalized patients with COVID-19 to trustworthy standards: a systematic review

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journal contribution
posted on 13.05.2022, 11:21 by Karen BurnsKaren Burns, Matthew Laird, James Stevenson, Kimia Honarmand, David Granton, Michelle E Kho, Deborah Cook, Jan O Friedrich, Maureen O Meade, Mark Duffett, Dipayan Chaudhuri, Kuan Liu, Frederick D'Aragon, Arnav Agarwal, Neill K J Adhikari, Hayle Noh, Bram Rochwerg, Academy of Critical Care: Development, Evaluation, and Methodology (ACCADEMY)
Importance: The COVID-19 pandemic created the need for rapid and urgent guidance for clinicians to manage COVID-19 among patients and prevent transmission.
Objective: To appraise the quality of clinical practice guidelines (CPGs) using the National Academy of Medicine (NAM) criteria.
Evidence review: A search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to December 14, 2020, and a search of related articles to February 28, 2021, that included CPGs developed by societies or by government or nongovernment organizations that reported pharmacologic treatments of hospitalized patients with COVID-19. Teams of 2 reviewers independently abstracted data and assessed CPG quality using the 15-item National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) instrument.
Findings: Thirty-two CPGs were included in the review. Of these, 25 (78.1%) were developed by professional societies and emanated from a single World Health Organization (WHO) region. Overall, the CPGs were of low quality. Only 7 CPGs (21.9%) reported funding sources, and 12 (37.5%) reported conflicts of interest. Only 5 CPGs (15.6%) included a methodologist, described a search strategy or study selection process, or synthesized the evidence. Although 14 CPGs (43.8%) made recommendations or suggestions for or against treatments, they infrequently rated confidence in the quality of the evidence (6 of 32 [18.8%]), described potential benefits and harms (6 of 32 [18.8%]), or graded the strength of the recommendations (5 of 32 [15.6%]). External review, patient or public perspectives, or a process for updating were rare. High-quality CPGs included a methodologist and multidisciplinary collaborations involving investigators from 2 or more WHO regions.
Conclusions and relevance: In this review, few COVID-19 CPGs met NAM standards for trustworthy guidelines. Approaches that prioritize engagement of a methodologist and multidisciplinary collaborators from at least 2 WHO regions may lead to the production of fewer, high-quality CPGs that are poised for updates as new evidence emerges.
Trial registration: PROSPERO Identifier: CRD42021245239.



The original is available at https://jamanetwork.com/

Published Citation

Burns KEA, et al. Adherence of clinical practice guidelines for pharmacologic treatments of hospitalized patients with COVID-19 to trustworthy standards: a systematic review. 2021;4(12):e2136263

Publication Date

10 December 2021

PubMed ID



  • School of Medicine
  • Undergraduate Research


American Medical Association.


  • Published Version (Version of Record)