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    Research Letter
    February 18, 2019

    Evidence-Based Medicine and the American Thoracic Society Clinical Practice Guidelines

    Author Affiliations
    • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
    • 2Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
    • 3Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
    JAMA Intern Med. 2019;179(4):584-586. doi:10.1001/jamainternmed.2018.7461

    The American Thoracic Society (ATS) issues clinical practice guidelines for the care of patients with pulmonary and critical care disease. The utility of ATS guidelines depends on the quality of the evidence base underpinning recommendations and whether the guidelines permit the practice of evidence-based medicine (EBM).1,2 However, the extent to which ATS guidelines are substantiated by high-quality evidence and can be used to promote EBM is unknown.

    Two of 3 investigators (R.C.S., K.D., and A.N.M.) reviewed each ATS clinical practice guideline recommendations listed on the ATS website as of August 1, 2017, that pertained to adults.3 We abstracted the following domains necessary for evidence-based clinical decision making based on prior conceptual frameworks1,2: recommendation type, recommendation strength (using the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] scoring system4 of strong [benefits clearly outweigh risks in most patients] vs low/conditional [benefits do not clearly outweigh risks in a substantial minority of patients]), quality of evidence (using GRADE categories4 of high [further research is unlikely to change estimate of effect] to very low [any estimate of effect is uncertain]), EBM measures, and patient context. Institutional review board approval was not needed because no human participants were included.