'Spring-cleaning' of Cochrane reviews and clinical guidelines in order to co-ordinate Cochrane reviews and clinical practice

Tags: Oral
Brok J, Greisen G, Christian G, Gluud L

Background The results of systematic reviews should be considered in clinical guidelines.

Objectives: To examine the agreement between systematic reviews completed by the Cochrane Neonatal Review Group and clinical guidelines for new-borns at a university department in Denmark.

Methods: Two authors independently graded 171 interventions for new-borns that were assessed in Cochrane Neonatal reviews (Cochrane Library issue 2, 2004). A 6-point scale was used to grade the extent to which the interventions were recommended in the reviews. Subsequently, the recommended use of identical interventions was extracted from clinical guidelines at the neonatal university department at Rigshospitalet in Copenhagen. The agreement between the recommendations of systematic reviews and the guidelines was analysed. In cases of agreement the authors of the clinical guidelines were asked whether the relevant Cochrane review(s) were considered. In cases of disagreement the authors of the clinical guidelines and the Cochrane reviewers were asked about reasons for the disagreement

Results: The recommendations presented in the reviews and guidelines were in agreement for most interventions (131 of 171). For 33 interventions there were minor discrepancies. For nine interventions the recommendations were not in agreement. Six of these interventions were recommended as the treatment of choice in the clinical guidelines, but not in the reviews. Three interventions were recommended in the reviews, but not in the guidelines. Reasons for disagreements varied but included, e.g., reservations about the external validity of the reviews and perceived economical constraint. One case of disagreements led to reconsidering of clinical guidelines. For employed interventions only 4/16 (25%) of the guideline authors had used the relevant Cochrane review when producing the guideline. Guideline authors pointed out few controversial conclusions in Cochrane reviews. We are examining the review authors explanations.

Conclusion: The majority of Cochrane neonatal reviews and clinical guidelines at Rigshospitalet are in agreement, but few authors of guidelines had actually used Cochrane reviews. 'Spring-cleaning' may co-ordinate Cochrane reviews and clinical guidelines and improves the quality of both.