Shekelle et al developed a model for determining when a clinical practice guideline should be updated. The need for change in a recommendation may be based on the availability of new information not available at the time the guidelines were formulated or the recognition of an issue requiring correction or clarification. The authors are from multiple institutions in the United States, England and Scotland.


Each guideline recommendation should be identified and assessed.


For each guideline recommendation, the questions for determining the current validity of the recommendation (modified from nodes in Figure 1, page 1463, Shekelle et al, JAMA, 2001).

(1) Does a limited (non-exhaustive) review of the literature identify new evidence sufficient to invalidate or change the guideline recommendation?

(2) Are there new developments or evidence in the field relevant to the guideline recommendation?

(3) If new developments or evidence in the field are available, are they of significant enough to invalidate or change the guideline recommendation?

(4) Are there new or additional recommendations within the boundaries of the original guideline that should be added or clarified?

(5) Do the consultant experts feel that the guideline recommendation should be updated?


If all of the responses to the above questions are "No", then the guideline recommendation probably does not need to be updated at this time.


Changes to a recommendation may include:

(1) clarification of a problem with the existing guideline

(2) addition of a new guideline (in addition to the existing guideline)

(3) replacement of an existing guideline

(4) modification of the existing guideline


As a general rule, guidelines should be reassessed for validity every 3 years (JAMA, 2001).


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