Table 4 Example of a single staging test and its thresholds in the presence of the target condition. The CPG scenario is based on considerations and signals found in our literature search, however, modified for illustrative purposes
| Â | Clinical healthcare example | GPG maintenance scenario |
|---|---|---|
Target condition | Arterial hypertension is present (≥ 140/90 mmHg) | The recommendation is outdated (There was new peer-reviewed scientific evidence published) |
Objective | To detect the severity, stage, or status of the prevalent hypertension so that an appropriate management option can be selected | To detect the severity, stage, or status of the prevalent outdatedness so that an appropriate management option can be selected |
Staging variable | Magnitude of pressure on artery walls in a free-living setting | Likelihood of potential changes in the strength of the recommendation |
Staging test | Ambulatory blood pressure monitoring | Survey among experts |
Staging test protocol | The patient receives a blood pressure measuring device to wear over the course of 24 h. The device is programmed to record the blood pressure once every 30 min. Blood pressure measurements are averaged for daytime and nighttime | A survey among experts is performed by using the results from the literature selection. Experts are given the current recommendation and literature, while being asked whether the newly identified literature is likely to change the recommendation’s strength requiring a dichotomous answer (yes/no) |
Staging test thresholds | Grade 1: 140–159 mmHg systolic and/or 90–99 mmHg diastolic arterial pressure Grade 2: 160–179 mmHg systolic and/or 100–109 mmHg diastolic arterial pressure Grade 3: ≥ 180 mmHg systolic and/or ≥ 110 mmHg diastolic arterial pressure | Very unlikely: 0–20% of the surveyed experts indicated that the new evidence is likely to change the strength of the recommendation when updated Reasonably unlikely: 20–40% of the surveyed experts indicated that the new evidence is likely to change the strength of the recommendation when updated Unclear: 40–60% of the surveyed experts indicated that the new evidence is likely to change the strength of the recommendation when updated Reasonable likely: 60–80% of the surveyed experts indicated that the new evidence is likely to change the strength of the recommendation when updated Very likely: 80–100% of the surveyed experts indicated that the new evidence is likely to change the strength of the recommendation when updated |