Clinical Practice Guideline Recommendations For Pediatric Multisystem Trauma Care

Abstract

To systematically review clinical practice guidelines (CPGs) for pediatric multisystem trauma, appraise their quality, synthesize the strength of recommendations and quality of evidence, and identify knowledge gaps. Background: Traumatic injuries are the leading cause of death and disability in children, who require a specific approach to injury care. Difficulties integrating CPG recommendations may cause observed practice and outcome variation in pediatric trauma care. Methods: We conducted a systematic review using Medline, Embase, Cochrane Library, Web of Science, ClinicalTrials, and grey literature, from January 2007 to November 2022. We included CPGs targeting pediatric multisystem trauma with recommendations on any acute care diagnostic or therapeutic interventions. Pairs of reviewers independently screened articles, extracted data, and evaluated the quality of CPGs using "Appraisal of Guidelines, Research, and Evaluation II." Results: We reviewed 19 CPGs, and 11 were considered high quality. Lack of stakeholder engagement and implementation strategies were weaknesses in guideline development. We extracted 64 recommendations: 6 (9%) on trauma readiness and patient transfer, 24 (38%) on resuscitation, 22 (34%) on diagnostic imaging, 3 (5%) on pain management, 6 (9%) on ongoing inpatient care, and 3 (5%) on patient and family support. Forty-two (66%) recommendations were strong or moderate, but only 5 (8%) were based on high-quality evidence. We did not identify recommendations on trauma survey assessment, spinal motion restriction, inpatient rehabilitation, mental health management, or discharge planning. Conclusions:We identified 5 recommendations for pediatric multisystem trauma with high-quality evidence. Organizations could improve CPGs by engaging all relevant stakeholders and considering barriers to implementation. There is a need for robust pediatric trauma research, to support recommendations.

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

“…However, our results do not clarify what the optimal age cutoff should be or whether other factors such as pubertal status and size should be accounted for. Although the American Academy of Pediatrics discourages the use of arbitrary age limits to guide clinical care, 82 the absence of age criteria in clinical decision rules, including triage tools 83 and clinical practice guidelines, 84 is a major barrier to their implementation.…”

Clinical practice guideline recommendations to improve the mental health of adult trauma patients: protocol for a systematic review

“…Pairs of reviewers with content expertise will independently assess CPGs quality based on the six domains of the AGREE II tool: 46 (1) scope and purpose (overall aim of the guideline; specific health questions and target population), (2) interested parties involvement (developed by the appropriate stakeholders; consistent with the views of its intended users), (3) rigorously developed (process used to gather and synthesise the evidence; methods to formulate and update the recommendations), (4) clarity and presentation (language; structure and format), ( 5) applicability (barriers and facilitators to implementation; Open access strategies to improve uptake such as integration into a national trauma performance verification process, tools for use at an organisational level, billing guidance for mental health practices, links to other relevant guidelines and tools and demand on healthcare resources) and ( 6) editorial independence (competing interests reported and addressed). In accordance with guidelines on the SR of CPGs 33 and based on previous SRs of CPGs, [47][48][49] each domain with a score≥60% will be considered effectively addressed. CPGs will be considered high quality if they score≥60% in at least three of the six AGREE II domains, including domain 3 (rigour of development).…”

“…Data synthesis CPG recommendations will be classified into the following key areas, as determined by the advisory committee: (1) mental health promotion/illness prevention, (2) screening for mental disorders, (3) assessment, (4) interventions, ( 5) referral for patients experiencing mental disorders for follow-up and support services and ( 6) patient and family centered-care approach. We will synthesise the evidence on recommendations for CPGs rated as moderate or high quality (AGREE II) 46 using a recommendation matrix based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence (high, moderate, low and very low), 50 recommendation strength (low and high), [47][48][49] health and social determinants (ie, care equity), and whether or not recommendations were formulated using a population-based approach. 45 Matrix data will be extracted independently by pairs or reviewers for each recommendation.…”