Table 2 Basic steps for the updating process of clinical practice guideline [43, 44]

1. Define the multidisciplinary group responsible for updating the specific CPG

2. Identify new relevant evidence: interval may vary from 6 months to 5 years

3. Assess if there was any change in the following set of circumstances:

  a. Evidence on the existing benefits and harms of interventions

  b. Outcomes considered important

  c. Available interventions

  d. Evidence that current practice is optimal

  e. Values placed on outcomes

  f. Resources available for health care

 In case of a positive answer to any of the above items from step 3, proceed to step 4

4. Updating process: systematic literature search, evidence selection, evidence synthesis, evidence assessment

5. External review

6. Publication and dissemination