Introducing the Rapid Review: How AGA is Working to Get Trustworthy Clinical Guidelines to Practitioners in Less Time

“Faster” is the new normative way of living and the demand for instant results affects every aspect of our lives. We want instant access to movies that can be streamed from our devices. We want our shopping purchases to be shipped to our door on the same day. We want the most reliable and accurate evidence to inform our clinical decisions — and we want it fast. “Rapid reviews” were borne out a desire to meet end-user needs in a rapidly changing health care environment.

Currently, AGA develops and publishes four or more clinical guidelines per year. These guidelines typically take around 12 months to conduct a systematic search and develop a complete draft of the technical review. In order to get AGA’s trustworthy, evidence-based clinical guidelines into the hands of practitioners in less time, a new project to pilot the use of “rapid reviews” has been commissioned. AGA’s upcoming guideline on the management of opioid-induced constipation (OIC) will be the first to utilize the rapid review approach.

What is a rapid review?

Simply stated, a rapid review is a systematic review completed more quickly than a standard systematic review.1 A traditional systematic review uses a predefined, systematic and transparent approach to identify, select, appraise and summarize primary studies addressing a focused clinical question using methods to reduce the likelihood of bias. Rapid reviews or guidelines are developed on a shorter timeline and use “methods to accelerate or streamline traditional [systematic review] processes” to meet the needs and timelines of the end-users.2, 3

While rapid reviews are conceptually quite simple, in reality, they are an ill-defined entity. Rapid reviews are highly variable with respect to terminology (often going by many names including rapid response, evidence advisory, hotline response, evidence summaries or evidence inventories), as well as with respect to methodology. While no two rapid reviews are alike, all may take certain methodological “shortcuts” to reduce the development time. True rapid reviews are akin to traditional systematic reviews with only minor differences in methodology; they are amenable to a shorter timeline because they ask a more targeted question with a reduced scope or are limited to specific outcomes. The timeline for development is often the critical factor that determines the methodological approach. For example, some “rapid reviews” are merely automated/algorithmic lists of titles of relevant references (completed in five minutes) while others are typically completed over eight months and are more consistent with traditional
systematic reviews.4-5


On average the typical timeline for the development of an AGA systematic review is 12 months, but the timeline for this rapid review will be three to six months.


Transparency has always been a hallmark of a high-quality systemic review. With no universal guiding methodological principles for rapid reviews, transparency of reporting is even more important when conducting a rapid review.4 When formulating rapid reviews and rapid guidelines, it is imperative to carefully describe the scope and methods of the review so the end-user is informed about any potential limitations.

Rapid Review and Guideline

In AGA’s first-ever rapid review and rapid guideline, three concise questions are to be answered regarding the management of OIC:

1. What is the effective medical therapy for OIC?
2. What are the harms of these medical therapies?
3. Are different costs of those therapies worth spending to achieve the stated benefits?

On average the typical timeline for the development of an AGA systematic review is 12 months, but the timeline for this rapid review will be three to six months. Methodological approaches that the technical review panel will use include limiting the number and scope of questions to be answered. Additionally, the panel will search for and use existing high-quality systematic reviews, include only English language articles, and not include review of grey literature , e.g. conference proceedings and technical reports. An initial title and abstract review followed by a full-text review will be performed by one reviewer and then only excluded titles/abstracts will be reviewed by a second author.6 The end-users of rapid reviews report that one of the most important factors, other than methodology and transparency, in considering the use of rapid reviews is that the review is from a reliable source.3 In a briskly and ever-changing medical field, AGA, a trusted leader in guideline development, is an ideal organization to lead the charge toward high-quality, rapid guideline development.

Dr. Hanson has no conflicts to disclose. Dr. Sultan has no conflicts to disclose.

References
1. Khangura S., Polisena J., Clifford T.J. et al, Rapid review: an emerging approach to evidence synthesis in health technology assessment. Int J Technol Assess Health Care. 2014;30:20-7.
2. Ganann R., Ciliska D., Thomas H. Expediting systematic reviews: methods and implications of rapid reviews. Implement Sci. 2010;5:56.
3. Hartling L., Guise J.M., Hempel S. et al, Fit for purpose: perspectives on rapid reviews from end-user interviews. Syst Rev. 2017;6:32.
4. Watt A., Cameron A., Sturm L. et al, Rapid versus full systematic reviews: validity in clinical practice?ANZ J Surg. 2008;78:1037-40.
5. Hartling L., Guise J.M., Kato E. et al,A taxonomy of rapid reviews links report types and methods to specific decision-making contexts. J Clin Epidemiol. 2015;68:1451-62.e3.
6. Haby M., Chapman E., Clark R., Barretto J. et al, What are the best methodlogies for rapid reviews of the research evidence for evidence-informed decision-making in health policy and practice: a rapid review. Health Research Policy and Systems. 2016; 14:83.

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