Incorporation of randomized controlled trials into organizational guidelines for obstetricians and gynecologists

Abstract

Incorporation of randomized controlled trials into organizational guidelines for obstetricians and gynecologists☆ Rigoberto Gutierreza, Matthew Bicoccab, Gregory Oparab, Megha Guptac, Michal Fishel Bartalb, Suneet P. Chauhanb, Stephen Wagnerd,⁎ a Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, AZ, USA b Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA c Department of Obstetrics, Gynecology, and Reproductive Sciences, Beth Israel Deaconess Medical Center, Boston, MA, USA d Department of Obstetrics, Gynecology, and Reproductive Sciences, Warren Alpert Medical School at Brown University, Providence, RI, USA article info Article history: Received 8 November 2021 Received in revised form 23 December 2021 Accepted 8 January 2022 Available online 12 January 2022 Keywords: Randomized controlled trials Practice guidelines Quality of evidence abstract Background: The American College of Obstetricians and Gynecologists publishes practice bulletins and committee opinions to serve as clinical guidelines for physicians. The objective of this study was to quantify the frequency that randomized controlled trials become incorporated into the American College of Obstetricians and Gynecologists documents (either practice bulletins or committee opinions). Methods: Original research articles published in The American Journal of Obstetrics and Gynecology, The Journal of the American Medical Association, The New England Journal of Medicine, and Obstetrics and Gynecology between 2009 and 2014 were examined and randomized controlled trials (RCT) in obstetrics and gynecology were identified. Adjusted odds ratio (aOR) with 95% confidence intervals (CI) were calculated to examine the factors associated with a citable RCT being referenced versus not in ACOG documents. Results: Of the 306 randomized controlled trials identified 248 (81.0%) met the inclusion criteria, with 128 (51.6%) of eligible RCT being cited The factors which increased the likelihood of a RCT being referenced, versus not being, were: if device or surgery was the intervention (aOR 3.60; 95% CI 1.85–7.00) and if the sample size of the trial was 500–999 (aOR 3.70 (1.39–9.82). The following factors were not associated with whether the RCT was or was not referenced in the ACOG documents: topic was obstetric or gynecologic, the trial was conducted in the US or abroad, multi- or single center, year of publication and the journal. Conclusion: Since about half of the citable randomized controlled trials published in obstetrics and gyne cology are incorporated into ACOG practice bulletins and committee opinions a greater transparency is warranted as to why RCTs are or are not referenced