Most Current ACEP Clinical Practice Guidelines Are Based on Expert Opinion and Low-Quality Evidence

Clinical policies have been developed by the American College of Emergency Physicians (ACEP) Clinical Policies Committee since 1990. For each policy, the ACEP rates both the strength of the recommendations (from Level A to C, with the latter being equivalent to inconclusive/limited evidence or committee consensus) and the level of evidence on which those recommendations have been made (from Class I to III, with the latter being case series/reports or expert consensus). These authors reviewed all 54 ACEP clinical policies issued from 1990–2015, analyzing the proportion of Level C recommendations and Class III evidence.

Overall, 48% of recommendations (200/421) were Level C, and 49% of evidence was Class III (1371 of 2801). Proportions were hi…