Author Affiliations: Division of Infectious Disease & Geographic Medicine, Stanford University, Stanford, California (Dr Deresinski); and Infectious Disease Section, Northeastern Ohio Universities College of Medicine, Rootstown, and Summa Health System, Akron, Ohio (Dr File).
In the process of clinical guideline development, the Infectious Diseases Society of America (IDSA) scores the level and quality of evidence for each recommendation. Lee and Vielemeyer,1 in examining IDSA guidelines published over an approximate 16-year period, found that only 14% of more than 4000 recommendations had been adjudicated to be based on level I evidence (ie, ≥1 properly conducted randomized controlled trial), a result almost identical to that reported in a very similar analysis published in 2010 in an IDSA journal.2
Deresinski S, File TM. Improving Clinical Practice Guidelines—The Answer Is More Clinical Research. Arch Intern Med. 2011;171(15):1401–1404. doi:10.1001/archinternmed.2011.345