Clinical practice guideline recommendations for pediatric solid organ injury care: A Systematic Review

Abstract

In a review of guidelines for pediatric solid organ injuries, we identified 5 recommendations based on moderate quality evidence or rated as strong; these reflected non-operative management and angioembolization for renal injuries and hospital stay for liver and spleen injuries.

Management of Pediatric Solid Organ Injuries

“…While the current literature discussing the management of pediatric SOI is overall relatively comprehensive, there do remain some gaps towards which future research may be directed. A recent systematic review of various clinical practice guidelines related to pediatric SOI found a paucity of recommendations specifically related to thromboprophylaxis, pain management, and nutritional support [137]. Recommendations related to thromboprophylaxis are especially needed, as SOI is a known risk factor for venous thromboembolism, yet thromboprophylaxis may be avoided due to concerns for delayed bleeding or differences in management compared to adult patients [138].…”

A systematic review assessing incorporation of prophylactic splenic artery embolisation (pSAE) into trauma guidelines for the management of high-grade splenic injury

“…Duplicate studies were excluded. Studies in the paediatric population were excluded given evidence on trauma management in this context is not comparable to adult populations [ 43 ]. Studies were also excluded when they were not in English ( n = 3), or when the full text could not be obtained ( n = 1).…”

“…Studies were scored as low when they scored less than 60% in 2 or more domains and less than 50% in domain 3. This determination was according to precedent from previous similar studies which have used this tool [ 43 , 45 ].…”

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.…”