The ESCMID framework for reaching consensus in clinical guidelines

As the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) continues to expand its guidelines programme, further methodological standardization is needed. This project aimed to develop a framework for standardizing consensus methods in ESCMID guideline panels.

Two scoping reviews were conducted to inform the framework: (i) a PubMed review to identify and map formal consensus methods used in guideline development, and (ii) a review of methodological guidance documents from national and international guideline-developing organizations to examine how consensus is operationalized in practice. Findings were synthesized using descriptive analyses and narrative synthesis and were integrated with ESCMID's methodological approach and feasibility considerations. The draft framework underwent stakeholder review and was revised accordingly before final approval by ESCMID governance bodies.

ESCMID developed a standardized framework for reaching consensus in guideline panels, centred on mandatory anonymous voting when issuing recommendations, with consensus defined as ≥80% agreement among voting members. The framework defines voting rights and participation requirements, standardizes voting options and outcome reporting, and establishes procedures to manage nonresponsiveness and address lack of consensus through iterative rewording and repeat voting rounds. Oversight and documentation requirements are specified to support transparency and consistency.

This framework represents an advancement in guideline development for ESCMID. It is designed to enhance quality, transparency, and consistency of ESCMID guidelines, while reducing sources of bias. Aligned with ESCMID's methodological rigour and commitment to evidence-based practice, it strengthens trustworthiness of ESCMID clinical guidelines.