AAN clinical practice guidelines

The American Academy of Neurology (AAN) has been a leader in developing clinical practice guidelines. Both the Quality Standards Subcommittee (QSS) and the Therapeutics and Technology Assessment Subcommittee (TTA) produce guidelines: “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”1 These guidelines aim to improve the quality of patient care and possibly the efficiency in use of health care resources.2

Clinical practice guidelines are typically based on 1) the best available peer-reviewed scientific evidence, 2) a consensus of expert opinion, or 3) a combination of these two sources.3 The AAN’s guideline development process aims at the evidence-based category, with little use for expert opinion.

Recently, methodologic standards for assessing the quality of guidelines have been suggested.2 Three dimensions of guideline characteristics are considered: 1) development and format, 2) evidence identification and summary, and 3) formulation of recommendations. Using these criteria, only 43% of the standards were met across a broad swathe of published guidelines.2 Of concern, only 15% of guidelines explicitly graded the scientific evidence and only 13% graded recommendations according to the strength of the evidence. These two critical standards are strengths of the AAN guideline development …