Ongoing Literature Surveillance and Guideline Updates

Ongoing Literature Surveillance and Clinical Practice Guideline Updates

Literature surveillance is the periodic scanning of literature to detect when guideline recommendations may require change. There are 2 times in the standard process that literature surveillance is often performed: During guideline development, and between versions of guidelines. In each case, the process for how to manage the literature is similar. 

Questions and Search Strategies

AAP staff (guideline staff in collaboration with the Bakwin Library) will collaborate to ensure that the search terms used for the systematic review are captured and run bi-annually post publication for a period of up to 3 years to capture any relevant literature that may negate or support clinical recommendations affirmed in the guidelines. Guideline staff will forward the results of the search to the epidemiologist, Chair, and Vice-Chair on a bin-annual basis for review to determine any potential need to update the guideline for a period of up to 3 years. Ideally, the search parameters for this search will be the same as for the original search, differing only by the period (dates) of ascertainment. Both MEDLINE and EMBASE allow users to set up a query that will return a list of abstracts that can be examined, on a quarterly (3-month) basis. Review of search strategy should be conducted periodically with the assistance of medical librarians, as MeSH headings will sometimes change or expand. Subcommittees may also decide to restrict the level of evidence in the incremental searches (eg, restrict search to higher-quality evidence). As with the original broad searches, search results are dependent upon quality of classification (eg, if filtering on study type, know that the classification of manuscripts in the database to be searched may not always be 100% accurate). Ideally, this list of abstracts will be seen by 2 reviewers and articles selected for full text review. Articles selected for full text review will be incorporated into evidence tables and recommendations/recommendation strength should be updated as affected by newly identified evidence. 

Time Stamps and Updates

Evidence-based clinical guidelines should be reviewed periodically, no later than every 5 years, but ideally every 3 years in accordance with other Academy policy prior to expiry, if: 

  • Literature surveillance suggests that significant changes in clinical practice would be supported by strong evidence; or  

  • Monitoring of implementations suggests that the current guideline results in care that would be unnecessarily harmful to patients.  

When an evidence-based clinical guideline is being renewed, the evidence search should be directed by clinical questions. If the clinical questions dictate that a broader search than the original should occur, then the subcommittee should decide how far back the additional clinical questions should be searched or whether a rapid evidence review process will be undertaken for those selected questions. Otherwise, the search should start from the end of the previous evidence search. The new evidence query should be constructed with the assistance of a methodologist (medical librarian or epidemiologist), as database qualifiers such as MeSH headings may have changed in the interim.  

If the previous evidence-based clinical guideline has been assessed and found to be methodologically sound, it can be cited, and original references do not have to be pulled, although evidence tables from previous versions of the guideline can be reviewed so that recommendations can potentially be regraded and/or evidence strength reassigned. AAP evidence-based clinical guidelines should refer transparently to the dates during which evidence is ascertained and search strategy used but need not specify an “expiration” date. If a guideline is sufficiently out of date and rework is not scheduled, the subcommittee may recommend not to renew it. 

Authoring Standards for Updates and Revisions

In order to reaffirm Clinical Practice Guidelines, guideline subcommittees must submit reaffirmation requests to the Committee on Guideline Development of the Council on Quality Improvement and Patient Safety.  If approved, the systematic review will be updated. Then the CPG subcommittee must convene to assess the implications of new, relevant literature on the prior key action statements (KASs) recommendations.   

Updated Guidelines

Updated guidelines include updated evidence for existing recommendations. 
  • Guidelines that have undergone an updated systematic review that do not result in changes to the KASs will be re-published as “UPDATED” [Guideline Name].   

  • Abstract inclusion: X Unchanged KASs 

  • Document body inclusion: Unchanged KASs 

Revised Guidelines

Revised guidelines included updated evidence for revised recommendations. 

  • Guidelines reaffirmations resulting in changes to KASs will be re-published as “REVISED” [Guideline Name]. 

  • Abstract inclusion: “This guideline contains: X New, X Changed, and X Unchanged KASs” 

  • Changes will be documented in the beginning of report with below areas: 

    • New KAS’s (if applicable) 

    • Changed KAS’s (if strength of evidence increased or decreased) 

    • Unchanged KAS’s 

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