Making useful clinical guidelines: the ESGAR perspective

Clinical guidelines are important and influential; they can improve processes involved in patient care, thereby also improving patient outcomes [1]. They are both commonly downloaded from journal websites and highly cited [2], helping clinical decision making and service commissioning. Yet, the quality of such guidelines is highly variable; a review of 279 guidelines published between 1985 and 1997 found that overall adherence to high-quality methodological standards was less than 50% [3]. Just as Altman [4] has argued that the misuse of statistics is unethical for primary research, it is equally inappropriate for guideline documents to recommend specific practices unless developed robustly and transparently. To do otherwise risks erroneous care, and, ultimately, patient harm. Readers of guidelines (clinicians, patients and policymakers) require reassurance that these authoritative documents have identified, appraised and considered the available evidence, or draw attention to weaknesses in the literature if appropriate.