Article type
Abstract
Background. Traditional scoping for a guideline relies on the knowledge, experience and practices of medical experts to develop PICO questions (AMSTAR). Yet, the pace of RCTs is exponentially increasing. We found one example where a panel of inter/national experts did not identify a major domain of successful treatment for depression, which already had numerous RCTs suggesting efficacy. This necessitated introspection and problem solving to prevent similar future recurrences.
Objectives. We describe the successes of adding a step to assure completeness of PICO(T)s for literature searching. We quantify potentially missed topics for comprehensive guidelines.
Methods. An additional method to better ensure completeness of updating for comprehensive guidelines was developed. The simplified search strategy of combining the diagnosis and randomization in Pubmed was pilot tested (rotator cuff ten* random*). This resulted in 5 additional PICO(T) topics. We next trialed the process with traumatic brain injury and randomized the medical expert panel into two groups: (1) updated PICO(T) list with the abbreviated search methodology vs. (2) usual PICO(T) development.
Results. We performed a scoping for a traumatic brain injury guideline update. The prior guideline (2017) had 62 PICO(T) questions. For the new guideline, we identified 2,869 hits in Pubmed 2017-2024 using “traumatic brain injury random*” as the simplified search strategy. Review of the abstracts resulted in identification of 22 new topics resulting in an additional 22 PICO(T) questions. The randomized group to usual PICO(T) development did not independently identify the new topics.
Conclusions. An abbreviated search method to enhance PICO(T) question development for comprehensive guidelines was successful. These results also show that the process of solely relying on medical experts for the purposes of comprehensive guidelines may be inadequate. We theorize this is becoming increasingly problematic in the world of hyperbolic growth in the evidence, with evermore published RCTs. There also may be a corollary for the multiple studies documenting 17-25 years for practices to change after evidence is produced. A limitation is that this abbreviated technique may still miss some new topics.
Objectives. We describe the successes of adding a step to assure completeness of PICO(T)s for literature searching. We quantify potentially missed topics for comprehensive guidelines.
Methods. An additional method to better ensure completeness of updating for comprehensive guidelines was developed. The simplified search strategy of combining the diagnosis and randomization in Pubmed was pilot tested (rotator cuff ten* random*). This resulted in 5 additional PICO(T) topics. We next trialed the process with traumatic brain injury and randomized the medical expert panel into two groups: (1) updated PICO(T) list with the abbreviated search methodology vs. (2) usual PICO(T) development.
Results. We performed a scoping for a traumatic brain injury guideline update. The prior guideline (2017) had 62 PICO(T) questions. For the new guideline, we identified 2,869 hits in Pubmed 2017-2024 using “traumatic brain injury random*” as the simplified search strategy. Review of the abstracts resulted in identification of 22 new topics resulting in an additional 22 PICO(T) questions. The randomized group to usual PICO(T) development did not independently identify the new topics.
Conclusions. An abbreviated search method to enhance PICO(T) question development for comprehensive guidelines was successful. These results also show that the process of solely relying on medical experts for the purposes of comprehensive guidelines may be inadequate. We theorize this is becoming increasingly problematic in the world of hyperbolic growth in the evidence, with evermore published RCTs. There also may be a corollary for the multiple studies documenting 17-25 years for practices to change after evidence is produced. A limitation is that this abbreviated technique may still miss some new topics.