Intensive Care Medicine

, Volume 44, Issue 7, pp 1189–1191 | Cite as

Scientific evidence underlying the recommendations of critical care clinical practice guidelines: a lack of high level evidence

  • Zhongheng Zhang
  • Yucai Hong
  • Ning Liu

Clinical practice guidelines (CPG) are widely used in critical care medicine (CCM). This study aimed to investigate the distributions of grade of evidence and recommendation in CCM, as well as factors influencing the recommendation classes. We hypothesized that the grade of evidence and publication year were independent determinants of the recommendation classes.

Electronic databases of PubMed and Scopus were searched from inception to March 2017 (details in Supplemental Material 1). CPGs in CCM developed under the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework were included. Data on the following variables were extracted: year of publication, topic of the CPG, recommendation class, and the grade of evidence. Grade levels A, B, C, and D correspond to high, moderate, low, and very low quality of evidence. To examine independent predictors of the recommendation class, a binary logistic regression model was constructed by incorporating variables...



The study was funded by Zhejiang Engineering Research Center of Intelligent Medicine (2016E10011) from the First Affiliated Hospital of Wenzhou Medical University and Zhejiang Provincial Natural Science Foundation of China (LGF18H150005).

Compliance with ethical standards

Ethical approval

The study did not involve human participants and ethics approval is not applicable.

Conflicts of interest

The authors declare that they have no competing interests.

Supplementary material

134_2018_5142_MOESM1_ESM.docx (209 kb)
Supplementary material 1 (DOCX 209 kb)
134_2018_5142_MOESM2_ESM.csv (3 kb)
Supplementary material 2 (CSV 2 kb)


  1. 1.
    Zhang Z (2016) Model building strategy for logistic regression: purposeful selection. Ann Transl Med 4:111. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Djulbegovic B, Kumar A, Kaufman RM et al (2015) Quality of evidence is a key determinant for making a strong GRADE guidelines recommendation. J Clin Epidemiol 68:727–732. CrossRefPubMedGoogle Scholar
  3. 3.
    Tricoci P, Allen JM, Kramer JM et al (2009) Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 301:831–841. CrossRefPubMedGoogle Scholar
  4. 4.
    Han H, Chao H, Guerra A et al (2015) Evolution of the American College of Cardiology/American Heart Association clinical guidelines. J Am Coll Cardiol 65:2726–2734. CrossRefPubMedGoogle Scholar
  5. 5.
    Poonacha TK, Go RS (2011) Level of scientific evidence underlying recommendations arising from the National Comprehensive Cancer Network clinical practice guidelines. J Clin Oncol 29:186–191. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Sir Run-Run Shaw HospitalZhejiang University School of MedicineHangzhouChina

Personalised recommendations