Clinical practice guidelines & test consequences 105 3 Methods Design In order to assess the types of supporting evidence used for CPG recommendations about diagnostic tests, and to identify factors related to the extent of the supporting evidence, we performed a systematic document analysis of recent versions of publicly accessible CPGs concerning 3 diagnostic topics. Topics We chose tests that are frequently used to diagnose three common diseases. We considered tests with different characteristics (primary vs. secondary care, negligible vs. reasonable risk of serious burden of the test, low vs. high costs) to identify possible factors related to differences in methodological approach in the development of the CPGs. We therefore selected the following tests: - C-reactive protein test (CRP) to increase the likelihood of pneumonia (annual incidence estimated at 0.5-1.1%) in primary care patients with cough (excluding diagnostic procedures in patients suspected of having a COVID-19 infection) [14] - Colonoscopy to detect colon cancer (annual incidence 1,148,515 new cases) in secondary care patients suspected of having (primary) colon cancer (excluding screening and tests in patients at risk of hereditary types of colon cancer) [15] - Fractional exhaled nitric oxide (FeNO) to diagnose (severe) asthma (prevalence 3.6%) in children and adults in primary and secondary care (excluding monitoring of asthma) [16] Search and selection of relevant CPGs Current, publicly accessible, recent (publication date 2016-2020) CPGs were eligible if they included recommendations about the tests mentioned above, were CPGs at a national or international level, and were published in English, German or Dutch. To identify relevant CPGs, one author (MT) performed the search and selected the CPGs. The selection was checked for accuracy by a second author (JB). In February 2021, we searched the International Guideline Library from Guidelines International Network (GIN, (https://guidelines.ebmportal.com/), including around 3000 CPGs, mostly developed by organizational GIN members), databases from organizational GIN members active in CPG development (n=103), the TRIP database (Turning Research Into Practice (https://www.tripdatabase.com/), containing around 10.000 Englishlanguage CPGs) and Medline (see Appendix1 for full search details).
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