Few AAP Guidelines Based on Strong Evidence

Research By: Armand Antommaria, MD, PhD, | Matthew Kelleher, MD, MEd | Rachel Peterson, MD

Post Date: March 11, 2025 | Publish Date: March 11, 2025

Hospital Medicine | Top Scientific Achievement

A new analysis conducted by Armand Matheny Antommaria, MD, PhD, Matthew Kelleher, MD, MEd, and Rachel Peterson, MD, from Cincinnati Children’s, reveals that only a small fraction of the American Academy of Pediatrics’ (AAP) clinical practice guideline recommendations are supported by the highest-quality evidence.

The research team reviewed the 14 current AAP guidelines and evaluated all 236 recommendations based on the quality of supporting evidence and the strength of each recommendation. Only 10.6% were grounded in Level A evidence—defined as well-designed, well-conducted trials or meta-analyses—while 47.5% relied on Level B evidence, and 27.1% on Level C, which includes a single or few observational studies.

While 34.7% of recommendations were rated “Strong,” many of these were not backed by the highest-quality studies. Details were published in April 2025 in Pediatrics.

“Our findings show that in pediatrics, where evidence-based care is the goal, much of our guidance still depends on moderate or low-quality data,” says corresponding author Antommaria. “This highlights the ongoing need to invest in pediatric clinical research to generate more high-quality evidence.”

These results are similar to those in other medical specialties, such as cardiology and infectious diseases; however, the authors emphasize the unique barriers in pediatric research, including smaller patient populations, limited funding, and challenges in enrolling children in trials. The authors urge further investment in research to strengthen future guideline development and improve clinical decision-making for children.

The team plans to study clinical practice guidelines written by other organizations as a next step.

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Publication Information

Original title:	Quality of Evidence and Strength of Recommendations in American Academy of Pediatrics’ Guidelines
Published in:	Pediatrics
Publish date:	March 11, 2025

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