National Guideline Clearinghouse

The National Guideline Clearinghouse (NGC) is an initiative of the Agency for Healthcare Research and Quality (AHRQ) External Web Site Policy, U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans [AHIP]). The NGC mission is to provide physicians and other health care professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use.


Updated Summary: Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. [American Society of Anesthesiologists]

Availability of Evidence Preparation of these guidelines followed a rigorous methodological process. Evidence was obtained from two principal sources: scientific evidence and opinion-based evidence (see appendix 2 in the original guideline document for detailed methods and analyses). Scientific evidence used in the development of these updated guidelines is based on […]


New Summary: Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. [American Society for Reproductive Medicine]

Definitions for the level of evidence (Level I-III) and strength of the recommendations (Grade A-C) are given at the end of the “Major Recommendations” field. Does Metformin Alone as First-Line Ovulation Induction Therapy Improve Clinical Pregnancy and Live-birth Rates Compared with Placebo? Summary Statements There is good evidence that metformin […]


Updated Summary: Neck pain: revision 2017. [American Physical Therapy Association, Inc., The Orthopaedic Section]

Levels of evidence (I–V) and grades of recommendation (A–F) are defined at the end of the “Major Recommendations” field. Note: These recommendations and clinical practice guidelines are based on the scientific literature published prior to August 2016. Pathoanatomical Features/Differential Diagnosis Clinicians should perform assessments and identify clinical findings in patients […]


New Summary: Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. [American Society of Colon and Rectal Surgeons]

Not applicable: The guideline was not adapted from another source. Society of American Gastrointestinal and Endoscopic Surgeons – Medical Specialty Society The funding bodies (American Society of Colon and Rectal Surgeons [ASCRS] and Society of American Gastrointestinal and Endoscopic Surgeons [SAGES]) did not influence the content of this work and […]


Updated Summary: Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. [International Pediatric Fever and Neutropenia Guideline Group]

Note from the National Guideline Clearinghouse: The International Pediatric Fever and Neutropenia Guideline Panel conducted systematic reviews of randomized trials (see the “Availability of Companion Documents” field) of interventions applied for the empirical management of pediatric fever and neutropenia (FN). Formulating Questions and Rating Importance of Outcomes The authors used […]


New Summary: BTS guideline for oxygen use in adults in healthcare and emergency settings. [British Thoracic Society]

The levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4), grades of recommendations (A-D), good practice points (GPPs), and recommendations for further research (RR) are defined at the end of the “Major Recommendations” field. Achieving Desirable Oxygen Saturation Ranges in Acute Illness (see sections 6 and 8 and […]


New Summary: Use of management pathways or algorithms in children with chronic cough: CHEST guideline and Expert Panel report. [American College of Chest Physicians]

Major Recommendations The grades of recommendation (1A–2C, consensus-based [CB]) and the approach to rating the quality of evidence are defined at the end of the “Major Recommendations” field. For children aged ≤14 years, the Expert Panel suggests defining chronic cough as the presence of daily cough of at least 4 […]


Updated Summary: Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST guideline and Expert Panel report. [American College of Chest Physicians]

Major Recommendations The grades of recommendation (1A–2C, consensus-based [CB]) and the approach to rating the quality of evidence are defined at the end of the “Major Recommendations” field. For children aged ≤14 years with chronic (> 4 weeks’ duration) wet or productive cough unrelated to an underlying disease and without […]


Updated Summary: Integrating tobacco interventions into daily practice. [Registered Nurses' Association of Ontario]

Definitions for the levels of evidence (Ia, Ib, IIa, IIb, III, IV, V) are provided at the end of the “Major Recommendations” field. Practice Recommendations Assessment Recommendation 1.1 Use brief interventions to screen all clients for all forms of tobacco use and initiate intervention as appropriate. (Levels of Evidence = […]


New Summary: Developmental follow-up of children and young people born preterm. [National Guideline Alliance]

Note from the National Guideline Clearinghouse (NGC): This guideline was developed by the National Guideline Alliance (NGA) on behalf of the National Institute for Health and Care Excellence (NICE). See the “Availability of Companion Documents” field for the full version of this guidance and related appendices. Information and Support for […]


New Summary: Clostridium difficile infection in adults and children. [University of Michigan Health System]

Not applicable: The guideline was not adapted from another source. The development of this guideline was funded by the University of Michigan Health System. Clostridium difficile Infection Guideline Team Team Leads: Tejal N Gandhi, MD, Infectious Diseases; Krishna Rao, MD, Infectious Diseases Team Members: Gregory Eschenauer, PharmD, Pharmacy; John Y […]


Updated Summary: Final recommendation statement: healthful diet and physical activity for cardiovascular disease prevention in adults without known risk factors: behavioral counseling. [U.S. Preventive Services Task Force]

This guideline summary has been replaced by an updated version. Please update your bookmarks. View the updated summary: Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force recommendation statement. NGC:010518 View all updated summaries […]


New Summary: ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. [American College of Gastroenterology]

Definitions of the quality of evidence (high, moderate, low, and very low) and strength of recommendations (strong and conditional) are provided at the end of the “Major Recommendations” field. Initial Assessment Evaluation and Risk Stratification A focused history, physical examination, and laboratory evaluation should be obtained at the time of […]


Updated Summary: Final recommendation statement: obesity in children and adolescents: screening. [U.S. Preventive Services Task Force]

Major Recommendations The U.S. Preventive Services Task Force (USPSTF) grades its recommendations (A, B, C, D, or I) and identifies the Levels of Certainty regarding Net Benefit (High, Moderate, and Low). The definitions of these grades can be found at the end of the “Major Recommendations” field. Recommendation Summary The […]


Updated Summary: Adult asthma care: promoting control of asthma, second edition. [Registered Nurses' Association of Ontario]

Definitions for the levels of evidence (Ia, Ib, IIa, IIb, III, IV, V) are provided at the end of the “Major Recommendations” field. Practice Recommendations Assessment Recommendation 1.1 At initial encounter, identify adults with an asthma diagnosis by reviewing the health record for an established asthma diagnosis, supported by the […]


Updated Summary: Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. [Society of Critical Care Medicine]

Definitions of the strength of recommendations (strong, weak, good practice) and quality of the evidence (high, moderate, low, very low) are provided at the end of the “Major Recommendations” field. Acute Respiratory Distress Syndrome (ARDS) I. Among adult patients with ARDS, should a neuromuscular-blocking agent (NMBA) be administered to improve […]


Updated Summary: KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease—mineral and bone disorder (CKD-MBD). [Kidney Disease: Improving Global Outcomes]

Search Strategy The Evidence Review Team (ERT) searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) for the date range of December 2006 through September 2015. The December 2006 date provided the recommended 1-year overlap with the end of the previous search. The search yield was also supplemented […]