Table 4.
Characteristics of all 349 discordant recommendations in UpToDate and proportion of appropriate discordant recommendations
| n (%) | Per cent of appropriate discordant (P value) | |
| Clinical Specialties | (P=0.160)* | |
| Primary Care and General internal Medicine | 15(4.3) | 53.3 |
| Emergency Medicine | 16(4.6) | 81.3 |
| Critical Care | 5(1.4) | 80.0 |
| Internal Medicine specialties | 158(45.3) | 57.6 |
| Oncology (including haemato-oncology) | 43(12.3) | 55.8 |
| Paediatrics | 73(20.9) | 47.9 |
| Obstetrics, Gynaecology and Women Health | 19(5.4) | 73.7 |
| General Surgery | 13(3.7) | 69.2 |
| Anaesthesiology | 3(0.9) | 100.0 |
| Psychiatry | 4(1.1) | 75.0 |
| Intervention type | (P=0.010) | |
| Drug intervention | 197(56.4) | 61.4 |
| Surgical interventions | 69(19.8) | 59.4 |
| Medical device | 24(6.9) | 62.5 |
| Behavioural or multidisciplinary intervention | 35(10.0) | 57.1 |
| Diagnostic test, screening programmes | 24(6.9) | 29.2 |
| Clarity of the comparator | (P<0.001) | |
| Comparator not at all clear—uncertain | 46(13.2) | 37.0 |
| Comparator not clearly and explicitly stated or obvious but relatively easy to infer | 120(34.4) | 48.3 |
| Comparator not clearly and explicitly stated but obvious | 110(31.5) | 68.2 |
| Comparator clearly and explicitly stated | 73(20.9) | 74.0 |
| Type of comparator | (P=0.083) | |
| Too unclear | 25(7.2) | 44.0 |
| No intervention (or placebo) | 126(36.1) | 54.0 |
| Other intervention(s) (standard of care or alternative(s)) | 198(56.7) | 63.1 |
| Direction of the recommendation | (P<0.001) | |
| For the intervention (ie, against the comparator) | 274(78.5) | 51.1 |
| Against the intervention (ie, for the comparator) | 75(21.5) | 85.3 |
| Mortality | (P<0.001) | |
| No statement about mortality | 189(54.2) | 47.1 |
| Implicit statement about mortality | 47(13.5) | 68.1 |
| Explicit statement about mortality | 113(32.4) | 73.5 |
| Balance of benefits and harms | (P<0.001) | |
| No statement about the balance of outcomes | 100(28.7) | 28.0 |
| Implicit statement about the balance of outcomes | 157(45.0) | 66.9 |
| Explicit statement about the balance of outcomes | 92(26.4) | 77.2 |
| Relative importance of outcomes—values and preferences | (P<0.001) | |
| No statement about the relative importance of outcomes | 168(48.1) | 42.9 |
| Implicit statement about the relative importance of outcomes | 171(49.0) | 73.1 |
| Explicit statement about the relative importance of outcomes | 10(2.9) | 70.0 |
| Cost of resources | (P=0.023) | |
| No statement about cost or resources | 334(95.7) | 57.2 |
| Cost or resources clearly and explicitly stated | 15(4.3) | 86.7 |
| Supporting SR | (P=0.175) | |
| No SR is cited | 300(86.0) | 56.3 |
| SR of observational studies | 22(6.3) | 63.6 |
| SR of both RCT and observational studies | 13(3.7) | 76.9 |
| SR of RCT | 14(4.0) | 78.6 |
| Design of primary studies | (P=0.002) | |
| No reference cited | 45(12.9) | 35.6 |
| Other type (eg, narrative review, book chapter) | 48(13.8) | 54.2 |
| Observational studies | 203(58.2) | 61.1 |
| RCT | 53(15.2) | 71.7 |
| Total | 349(100) | 58.5 |
*The null hypothesis for the p value is that the proportions do not differ across categories.
RCT, randomised controlled trials; SR, systematic review.