Community-acquired Pneumonia Guideline Recommendations-Impact of a Consensus-based Process versus Systematic Reviews

Area of Science:

• Medical Guidelines Development
• Evidence-Based Medicine
• Clinical Practice Guidelines

Background:

• The American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) developed Community-acquired Pneumonia (CAP) guidelines using systematic reviews.
• Institute of Medicine Standards emphasize systematic reviews for trustworthy guidelines.
• Recent studies indicate the Convergence of Opinion on Recommendations and Evidence (CORE) process may yield concordant recommendations.

Purpose of the Study:

• To evaluate the efficacy of the CORE process if it had been used for the ATS/IDSA CAP guidelines.
• Compare CORE-derived recommendations with existing guideline recommendations.

Main Methods:

• Recruited CAP experts not involved in the original guideline development.
• Experts participated in the CORE process, addressing the same guideline questions.
• Compared CORE recommendations to guideline recommendations on course of action, strength, and evidence quality.

Main Results:

• The CORE process generated recommendations for 20 of 31 questions (65%) using a 70% expert consensus threshold.
• 19 of 20 CORE recommendations (95%) were concordant with guideline recommendations (kappa agreement 0.88).
• Lower agreement was observed for strength of recommendation (58%) and quality of evidence (42%).

Conclusions:

• The CORE process could have been used to develop the ATS/IDSA CAP guidelines.
• This method could potentially reduce the number of systematic reviews required (11 vs. 31).
• The CORE process demonstrated high concordance with guideline recommendations for the course of action.