Clinical practice guidelines & test consequences 107 3 We planned to analyse a possible relation between differences in evidence base and methodological factors (e.g. composition of the CPG panel, involvement of patients and methodologists, development approach). However, because the data about the evidence base were quite homogenous we were not able to perform these analyses. Results Search and selection of relevant CPGs Full details of the search and selection process are described in Appendix 1. In short, the search identified 15 unique relevant recommendations in 15 CPGs: four about CRP related to the diagnosis pneumonia in primary care [19-22], five about colonoscopy in secondary care patients suspected of having colon cancer [23-27], and six about the use of FeNO to diagnose (severe) asthma [28-33]. The search and selection process is illustrated in figure 2. In table 1, we present the included CPGs with information about the developing organisation, the country of publication and the publication year. All guidelines originated from high-income countries. Quality of the guidelines and use of the GRADE approach Table 2 presents detailed information about the composition of the CPG panel, the methodological quality of the included CPGs, the direction and grading of the recommendation and the reported and actual use of the GRADE approach. Nine out of 15 CPGs included a methodologist in the development process, in the CPG panel and/or at bureau level [23, 24, 27-33]. In all CPGs about FeNO a methodologist was involved, and in none of the CPGs about CRP. Patient involvement and inclusion of patient perspective varied a lot between the CPGs. AGREE II methodology domain scores varied from 8 to 42 (possible range from worst to best: 6-42), with the highest scores for the CPGs about FeNO. Thirteen of the included recommendations were in favour of the test of interest, only one recommendation about CRP [22], and one recommendation about FeNO [28], advised against the use of the test. Eleven recommendations were graded, which included all recommendations about CRP [1922], two out of five recommendations about colonoscopy [25, 26], and five out of six recommendations about FeNO [28-30, 32, 33]. Seven CPGs reported to have used the GRADE approach [20, 21, 24, 28-30]; in four of these elements of the GRADE approach (such as a GRADE evidence profile) were recognized [24, 28-30]. No clear differences between the topics were identified in the (reported) use of the GRADE approach.
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