Clinical practice guideline recommendations for pediatric injury care: protocol for a systematic review

Abstract

IntroductionEvidence suggests the presence of deficiencies in the quality of care provided to up to half of all paediatric trauma patients in Canada, the USA and Australia. Lack of adherence to evidence-based recommendations may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aim to systematically review CPG recommendations for paediatric injury care and appraise their quality.Methods and analysisWe will identify CPG recommendations through a comprehensive search strategy including Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, Cochrane library, Web of Science, ClinicalTrials and websites of organisations publishing recommendations on paediatric injury care. We will consider CPGs including at least one recommendation targeting paediatric injury populations on any diagnostic or therapeutic intervention from the acute phase of care with any comparator developed in high-income countries in the last 15 years (January 2007 to a maximum of 6 months prior to submission). Pairs of reviewers will independently screen titles, abstracts and full text of eligible articles, extract data and evaluate the quality of CPGs and their recommendations using Appraisal of Guidelines Research and Evaluation (AGREE) II and AGREE Recommendations Excellence instruments, respectively. We will synthesise evidence on recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework and present results within a recommendations matrix.Ethics and disseminationEthics approval is not a requirement as this study is based on available published data. The results of this systematic review will be published in a peer-reviewed journal, presented at international scientific meetings and distributed to healthcare providers.PROSPERO registration numberInternational Prospective Register of Systematic Reviews (CRD42021226934).

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

“…A comprehensive description of the methods followed in this systematic review is available in a peer-reviewed protocol. 6 The study was designed using Cochrane guidelines 7 and recommendations for systematic reviews of CPGs. 8 The following is a summary of our methodology reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (Supplemental Digital Content, Supplementary Data 1, http://links.lww.com/TA/D71).…”

“…A comprehensive description of the methods followed in this systematic review is available in a peer-reviewed protocol 6 . The study was designed using Cochrane guidelines 7 and recommendations for systematic reviews of CPGs 8 .…”

“…independently evaluated the quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 11 which includes six domains: scope and purpose (overall aim of the guideline, specific health questions, and target population), stakeholder involvement (developed by the appropriate stakeholders, represents the views of its intended users), rigor of development (process used to gather and synthesize the evidence, methods to formulate and update the recommendations), clarity and presentation (language, structure, and format), applicability (barriers and facilitators to implementation, strategies to improve uptake, implications for health care resource utilization), and editorial independence (competing interests reported and addressed). Following recent recommendations 8 and as stated in our protocol, 6 CPGs were considered as high quality if they scored ≥60% in three or more domains including domain 3, rigor of development; they were considered as moderate quality if three or more domains scored ≥60% but domain 3 was <60%; they were considered as low quality if CPGs scored <60% in two or more domains and domain 3 was <50%.…”

“…We searched Excerpta Medica dataBASE, Medical Analysis and Retrieval System Online via PubMed, and Web of Science from January 1, 2007, to November 8, 2022, with no language restrictions (Supplemental Digital Content, Supplementary Data 1, http://links.lww.com/ TA/D70). We also searched the websites of organizations publishing recommendations on pediatric injury care, 6 identified by the project steering committee (Supplemental Digital Content, Supplementary Data 2, http://links.lww.com/TA/D70).…”

“…Recommendations for multisystem trauma have been synthesized in a separate review. 6 Furthermore, we did not include clinical decision rules such as Pediatric Emergency Care Applied Research Network (PECARN) rule because they do not correspond to our definition of a CPG. However, clinical decision rules are often based on recommendations from CPGs.…”