The anatomy of a US Preventive Services Task Force Recommendation: lipid screening for children and adolescents

Abstract

Differing methods for guideline development result in conflicting recommendations and clinical practice variation. This article details the approach used by the US Preventive Services Task Force to issue recommendation statements, using the 2007 recommendation for screening of lipid levels as an example. An analytic framework served as the source of key questions for a systematic review of the evidence on lipid screening in children and adolescents. Evidence was insufficient, of poor quality, or conflicting to answer 7 of the 10 questions. There was no direct evidence of the benefit of lipid screening, and insufficient evidence existed in the indirect chain of evidence to support a recommendation. In 2008, the American Academy of Pediatrics issued a clinical policy statement recommending screening for targeted children. We discuss the contrasting approach to the development of this guideline. The use of a standardized method to develop clinical guidelines promotes trust and credibility among patients and clinicians.