title: Appraisal of the Quality of Neurosurgery Clinical Practice Guidelines.
abstract: OBJECTIVE
  The rate of neurosurgery guidelines publications was compared over time with all other specialties. Neurosurgical guidelines and quality of supporting evidence were then analyzed and compared by subspecialty.
  
  
  METHODS
  The authors first performed a PubMed search for "Neurosurgery" and "Guidelines." This was then compared against searches performed for each specialty of the American Board of Medical Specialties. The second analysis was an inventory of all neurosurgery guidelines published by the Agency for Healthcare Research and Quality Guidelines clearinghouse. All Class I evidence and Level 1 recommendations were compared for different subspecialty topics.
  
  
  RESULTS
  When examined from 1970-2010, the rate of increase in publication of neurosurgery guidelines was about one third of all specialties combined (P < 0.0001). However, when only looking at the past 5 years the publication rate of neurosurgery guidelines has converged upon that for all specialties. The second analysis identified 49 published guidelines for assessment. There were 2733 studies cited as supporting evidence, with only 243 of these papers considered the highest class of evidence (8.9%). These papers were used to generate 697 recommendations, of which 170 (24.4%) were considered "Level 1" recommendations.
  
  
  CONCLUSIONS
  Although initially lagging, the publication of neurosurgical guidelines has recently increased at a rate comparable with that of other specialties. However, the quality of the evidence cited consists of a relatively low number of high-quality studies from which guidelines are created. Wider implications of this must be considered when defining and measuring quality of clinical performance in neurosurgery.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA. Electronic address: katrina.ducis@uvmhealth.org.
authors.forename: Katrina
authors.initials: K
authors.lastname: Ducis
authors.affiliation: Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Florman
authors.affiliation: Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA; Center for Excellence in Neuroscience, University of New England, Biddeford, Maine, USA.
authors.forename: Anand I
authors.initials: AI
authors.lastname: Rughani
mesh_terms: D033181:Information Dissemination / Q000379:methods*; D009493:Neurosurgery / Q000592:standards* / Q000706:statistics & numerical data*; D010506:Periodicals as Topic / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic / Q000592:standards*; D039781:PubMed / Q000706:statistics & numerical data*; D011643:Publishing / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data
keywords: Clinical guidelines; Evidence-based medicine; Practice guidelines; Quality of health care