Article
An adapted approach to Identify Evidence-Based Clinical Practice Guidelines for Prehospital Management of Time-Sensitive Critical Conditions
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Authors
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O. Hoogmartens
- Faculty of Medicine, University of Louvain, Leuven, Belgium
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M. Castren
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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H. Borovsky
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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M. Sabbe
- Faculty of Medicine, University of Louvain, Leuven, Belgium
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B. Aertgeerts
- Faculty of Medicine, University of Louvain, Leuven, Belgium
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D. Ramaekers
- Faculty of Medicine, University of Louvain, Leuven, Belgium
| Published: | July 10, 2012 |
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Outline
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Background: Evidence Based Standardization of practice amongst prehospital care workers is a research topic which is being increasingly investigated. For prehospital practitioners, it is virtually impossible to distinguish evidence-based from low quality or even harmful recommendations. Rapid methods to find existing evidence, and summarize them into clinical practice recommendations are needed.
Objectives: This systematic literature review uses an adapted approach to generate evidence based clinical practice recommendations for the prehospital care of patients with traumatic brain injury.
Methods: We performed a systematic search for existing clinical practice guidelines on TBI in electronic databases and specialty websites. The references of eligible guidelines were screened for prehospital recommendations. A rapid review was conducted to identify recently published studies for several specific interventions used in the management of TBI. Evidence sifting and quality appraisal was performed using the GRADE working group methods.
Results: We found 13 different guidelines on TBI in accordance to our inclusion criteria. In addition, our rapid review retrieved 27 relevant citations. We identified 20 different interventions that should be included in future guidelines on prehospital management of TBI. Most importantly are the use of Rapid Sequence Intubation, capnography monitoring and regulation of TBI patients to the most appropriate trauma center.
Implications: The content of multiple existing guidelines on the management of TBI differed widely. This large variation prevents effective use by health care workers in the field. To prevent patient harm, inclusion of existing guidelines in both basic and continuous training should be done cautiously.
