OBJECTIVES: To describe divergence between actionable statements issued by coronavirus disease 2019 (COVID-19) guideline developers cataloged on the "COVID-19 Recommendations and Gateway to Contextualization" platform. STUDY DESIGN AND SETTING: We defined divergence as at least two comparable actionable statements with different explicit judgments of strength, direction, or subgroup consideration of the population or intervention. We applied a content analysis to compare guideline development methods for a sample of diverging statements and to evaluate factors associated with divergence. RESULTS: Of the 138 guidelines evaluated, 85 (62%) contained at least one statement that diverged from another guideline. We identified 223 diverging statements in these 85 guidelines. We grouped statements into 66 clusters. Each cluster addressed the same population, intervention, and comparator group or just similar interventions. Clinical practice statements were more likely to diverge in an explicit judgment of strength or direction compared to public health statements. Statements were more likely to diverge in strength than direction. The date of publication, used evidence, interpretation of evidence, and contextualization considerations were associated with divergence. CONCLUSION: More than half of the assessed guidelines issued at least one diverging statement. This study helps in understanding the types of differences between guidelines issuing comparable statements and factors associated with their divergence.

American College of Physicians Philadelphia PA USA

Amsterdam University Medical Centers location Academic Medical Center University of Amsterdam Amsterdam Public Health Research Institute Meibergdreef 9 1105AZ Amsterdam The Netherlands

Bruyere Research Institute Centre for Studies in Family Medicine Western University London Ontario N6A 3K7 Canada

Cochrane South Africa South African Medical Research Council Cape Town South Africa; Division of Clinical Pharmacology Department of Medicine and Division of Epidemiology and Biostatistics Department of Global Health Stellenbosch University Cape Town South Africa

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Kamenice 5 625 00 Brno Czech Republic; Institute of Health Information and Statistics of the Czech Republic Palackého náměstí 4 128 01 Prague 2 Czech Republic

Department of Anesthesiology and Critical Care Medicine Division of Critical Care Medicine Université Laval Québec City Canada; Population Health and Optimal Health Practices Research Unit CHU de Québec Université Laval Research Center Québec City Canada

Department of Biomedical Sciences for Health University of Milan Milan Italy

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada; Biostatistics Unit The Research Institute St Joseph's Healthcare Hamilton Ontario Canada

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada; Department of Internal Medicine Pontificia Universidad Catolica de Chile Avenida Libertador General Bernardo O'Higgins 340 Santiago Chile

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada; Department of Medicine McMaster University Hamilton Ontario Canada

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada; Michael G DeGroote Cochrane Canada and GRADE Centre McMaster University Hamilton Ontario Canada

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada; Michael G DeGroote Cochrane Canada and GRADE Centre McMaster University Hamilton Ontario Canada; Department of Medicine McMaster University Hamilton Ontario Canada; Cochrane Germany Cochrane Germany Foundation Freiburg Germany; Dipartimento di Scienze Biomediche Humanitas University Milan Italy

Departments of Science and International Studies St Elizabeth University of Public Health and Social Science Bratislava Slovak Republic

Faculty of Dentistry Department of Oral Medicine and Periodontology Cairo University Cairo Egypt

Faculty of Health Sciences Queen's University 18 Barrie Street Kingston Ontario K7L 3N6 Canada

Iberoamerican Cochrane Centre Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau Barcelona Spain

Institute for Evidence in Medicine Medical Center and Faculty of Medicine University of Freiburg Freiburg Germany; Cochrane Germany Cochrane Germany Foundation Freiburg Germany

Norwegian Institute of Public Health P O Box 222 Skøyen 0213 Oslo Norway

Norwegian Institute of Public Health P O Box 222 Skøyen 0213 Oslo Norway; University of Oslo P O Box 1130 Blindern 0318 Oslo Norway

Postgraduate Institute of Medical Education and Research Chandigarh India

School of Epidemiology and Public Health University of Ottawa Canada; Bruyere Research Institute Ottawa Canada

School of Epidemiology and Public Health University of Ottawa Canada; Bruyere Research Institute Ottawa Canada; Department of Medicine University of Ottawa Ottawa Ontario K1H 8M5 Canada

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