Article type
Abstract
Background:
The Infectious Diseases Society of America (IDSA) COVID-19 Diagnosis Panel published living and rapid guidelines during the pandemic. In this article, we provide a summary of barriers to developing those guidelines and the lessons learned (Table 1).
Methods:
The methods team drafted an initial list of barriers and suggested solutions. Through an iterative process of semi-structured discussion and written communication, the clinical experts contributed, and the methods team made appropriate edits to reflect the group’s consensus.
Results:
- Single vs multiple recommendations update:
Recognizing a change in a single diagnostic approach could directly impact the next step in testing or management; the guideline development group opted to release updated recommendations simultaneously rather than single recommendations. This allowed for the creation of visual decision trees/algorithms that were useful for clinicians and decision-makers.
-Reference standard modifications:
With COVID-19, the accepted reference standard was established to be the nucleic acid amplification tests. The literature, however, included a variety of reference standards with most of them falling out of favor as the pandemic progressed. For groups planning to develop diagnostic guidelines, it would be important to discuss the optimal reference standard.
- patients vs public perspective:
Because of the highly communicable nature of the disease, the recommendations for testing related not just to the patient, but to the community. Thus, groups planning to develop recommendations around communicable diseases should consider what perspective the recommendations will use and how that would align with the goals of the end user.
- Context for implementation considerations:
variations in the incidence and the pretest probability were common early in the pandemic and frequently changed during outbreaks. Additionally, the pretest probability varied across symptomatic and asymptomatic individuals, those with known exposure, and vaccination status. To address these issues, we considered multiple prevalence values and pre-test probabilities for each recommendation.
Conclusions:
The conduct of diagnostic guidelines within the setting of a pandemic was a challenge that left us with many lessons. Those lessons are relevant for groups developing guidelines, those interested in the rapid and living guidelines approach, or decision-makers interested in building on this experience for other contexts.
The Infectious Diseases Society of America (IDSA) COVID-19 Diagnosis Panel published living and rapid guidelines during the pandemic. In this article, we provide a summary of barriers to developing those guidelines and the lessons learned (Table 1).
Methods:
The methods team drafted an initial list of barriers and suggested solutions. Through an iterative process of semi-structured discussion and written communication, the clinical experts contributed, and the methods team made appropriate edits to reflect the group’s consensus.
Results:
- Single vs multiple recommendations update:
Recognizing a change in a single diagnostic approach could directly impact the next step in testing or management; the guideline development group opted to release updated recommendations simultaneously rather than single recommendations. This allowed for the creation of visual decision trees/algorithms that were useful for clinicians and decision-makers.
-Reference standard modifications:
With COVID-19, the accepted reference standard was established to be the nucleic acid amplification tests. The literature, however, included a variety of reference standards with most of them falling out of favor as the pandemic progressed. For groups planning to develop diagnostic guidelines, it would be important to discuss the optimal reference standard.
- patients vs public perspective:
Because of the highly communicable nature of the disease, the recommendations for testing related not just to the patient, but to the community. Thus, groups planning to develop recommendations around communicable diseases should consider what perspective the recommendations will use and how that would align with the goals of the end user.
- Context for implementation considerations:
variations in the incidence and the pretest probability were common early in the pandemic and frequently changed during outbreaks. Additionally, the pretest probability varied across symptomatic and asymptomatic individuals, those with known exposure, and vaccination status. To address these issues, we considered multiple prevalence values and pre-test probabilities for each recommendation.
Conclusions:
The conduct of diagnostic guidelines within the setting of a pandemic was a challenge that left us with many lessons. Those lessons are relevant for groups developing guidelines, those interested in the rapid and living guidelines approach, or decision-makers interested in building on this experience for other contexts.