Scope, Quality, and Inclusivity of Clinical Guidelines Produced Early in the COVID-19 Pandemic: Rapid Review
Open accessAbstract
Objective: To appraise the availability, quality, and inclusivity of clinical guidelines produced in the early stage of the coronavirus disease 2019 (covid-19) pandemic. Design: Rapid review. Data sources: Ovid Medline, Ovid Embase, Ovid Global Health, Scopus, Web of Science Core Collection, and WHO Global Index Medicus, searched from inception to 14 Mar 2020. Search strategies applied the CADTH database guidelines search filter, with no limits applied to search results. Further studies were identified through searches of grey literature using the ISARIC network. Inclusion criteria: Clinical guidelines for the management of covid-19, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) produced by international and national scientific organisations and government and non-governmental organisations relating to global health were included, with no exclusions for language. Regional/hospital guidelines were excluded. Only the earliest version of any guideline was included. Quality assessment: Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The quality and contents of early covid-19 guidelines were also compared with recent clinical guidelines for MERS and SARS. Results: 2836 studies were identified, of which 2794 were excluded after screening. Forty two guidelines were considered eligible for inclusion, with 18 being specific to covid-19. Overall, the clinical guidelines lacked detail and covered a narrow range of topics. Recommendations varied in relation to, for example, the use of antiviral drugs. The overall quality was poor, particularly in the domains of stakeholder involvement, applicability, and editorial independence. Links between evidence and recommendations were limited. Minimal provision was made for vulnerable groups such as pregnant women, children, and older people. Conclusions: Guidelines available early in the covid-19 pandemic had methodological weaknesses and neglected vulnerable groups such as older people. A framework for development of clinical guidelines during public health emergencies is needed to ensure rigorous methods and the inclusion of vulnerable populations. Systematic review registration: PROSPERO CRD42020167361.
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Inconsistent recommendations primarily originate from connections with unclear underlying evidence.
“The inconsistent recommendations primarily originate from connections with unclear underlying evidence [146,157].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [157]
The Discussion (‘Variation in recommendations’; page not supplied) reports that recommendations varied and that unclear links to underlying evidence made the reasoning behind them hard to ascertain. It does not say those unclear links were the primary cause of the inconsistency; it says complex factors were involved. (LLM, conf=0.86)
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- Authors
- Dagens, A., Sigfrid, L., Cai, E., Lipworth, S., Cheng, V., Harris, E., Bannister, P., Rigby, I., & Horby, P.
- Affiliations
- University of Oxford (GB)
- University of Bristol (GB)
- Brighton and Sussex Medical School (GB)
- Corresponding author
- Dagens, Andrew
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-05-26
- Volume
- 369
- Pages
- m1936
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC7249097
- OpenAlex
- W3030082895
- Cited by
- 156
- References
- 24
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 8 · 2023: 18 · 2022: 37 · 2021: 60 · 2020: 23
- FWCI
- 5.77
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-06-12)
- Open access
- hybrid
- doi.org
- Locations
- BMJ (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Explore Bristol Research (submittedVersion, cc-by)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- COVID-19 pandemic, clinical guidelines, guideline quality, vulnerable populations, MERS, SARS, public health emergencies, stakeholder engagement, editorial independence, antiviral agents, older adults
- MeSH terms
- Betacoronavirus, Systematic Reviews as Topic, COVID-19, SARS-CoV-2, Adrenal Cortex Hormones, Antiviral Agents, Humans, Oxygen Inhalation Therapy, Pneumonia, Viral, World Health Organization, Practice Guidelines as Topic, Coronavirus Infections, Vulnerable Populations, Severe Acute Respiratory Syndrome, Venous Thromboembolism, Pandemics
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