Updating clinical guidelines

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We obtained the full-text articles of the potentially eligible references for further assessment.Disagreements were solved by consensus and, if necessary, with the help of a third reviewer (LMG).].We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to the extent it was applicable to our study [We included all updated CGs published in 2015 (as the most recent year prior to publication of Check Up) which met the following criteria: (1) developed by a professional society, (2) search strategy using at least one bibliographic database, (3) reporting at least one recommendation, (4) updated version of a previous version of the same CG (including a reference to a previous version of the CG), and (5) published in English.Two reviewers (RV, IDF, LHA, or MHFP) independently screened the titles and abstracts to identify potentially eligible references.We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation.Three reviewers independently assessed the CGs with Check Up (16 items).We aimed to examine (1) the completeness of reporting the updating process in CGs and (2) the inter-observer reliability of Check Up.We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using Check Up.

Additionally, we calculated the overall score (median and range) by summing up all scores of the individual items.

We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale.

Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs.

Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs) and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs).

CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (The reporting of updated CGs varies considerably with significant room for improvement.

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