Practice guidelines need to be up-to-date to be useful to clinicians.
No published methods are available for assessing whether existing practice
guidelines are still valid, nor does any empirical information exist regarding
how often such assessments need to be made.
To assess the current validity of 17 clinical practice guidelines published
by the US Agency for Healthcare Research and Quality (AHRQ) that are still
in circulation, and to use this information to estimate how quickly guidelines
Design, Setting, and Participants
We developed criteria for defining when a guideline needs updating,
mailed surveys to members of the original AHRQ guideline panels (n = 170;
response rate, 71%), and searched the literature for evidence through March
2000 (n = 6994 titles yielding 173 articles plus 159 new guidelines on the
Main Outcome Measures
Identification of new evidence calling for a major, minor, or no update
of the 17 guidelines; survival analysis of the rate at which guidelines became
For 7 guidelines, new evidence and expert judgment indicated that a
major update is required; 6 were found to be in need of a minor update; 3
were judged as still valid; and for 1 guideline, we could reach no conclusion.
Survival analysis indicated that about half the guidelines were outdated in
5.8 years (95% confidence interval [CI], 5.0-6.6 years). The point at which
no more than 90% of the guidelines were still valid was 3.6 years (95% CI,
More than three quarters of the AHRQ guidelines need updating. As a
general rule, guidelines should be reassessed for validity every 3 years.