OBJECTIVE: This study appraised the completeness and level of evidence behind prehospital recommendations in clinical practice guidelines (CPGs) for management of severe traumatic brain injury (TBI). Differences and similarities in key recommendations for prehospital emergency care were assessed between current CPGs. METHODS: A systematic search identified current evidence-based CPGs for the management of severe TBI. The identified CPGs were screened for prehospital recommendations. Finally, an evaluation of the completeness and level of evidence for each of the identified recommendations was carried out. A review of the literature identified additional evidence. Designs of the retrieved publications were considered and classified according to the GRADE levels of evidence. RESULTS: This study identified 12 current CPGs for the management of patients after traumatic brain injury. Of these, twenty-one prehospital recommendations were selected. Only a few CPGs made recommendations on temperature management and ventilation patterns. Statements on prehospital transport and advanced airway management were common to all of the guidelines. Statements on initial treatment demonstrated the greatest variability. The literature review identified several relevant publications not included in the CPGs even after we controlled for the indicated time-intervals of their literature search. In addition, evidence from more recent trials published outside the search-interval of the clinical practice guidelines was found. CONCLUSIONS: The use of current guidelines on traumatic brain injury will not always facilitate decisions about best or most appropriate practice for prehospital practitioners. The amount of recommended prehospital interventions varied considerably, and there was large content variation in prehospital recommendations in these guidelines. Not all evidence was taken into account and not all CPGs were up-to-date.
OBJECTIVE: This study appraised the completeness and level of evidence behind prehospital recommendations in clinical practice guidelines (CPGs) for management of severe traumatic brain injury (TBI). Differences and similarities in key recommendations for prehospital emergency care were assessed between current CPGs. METHODS: A systematic search identified current evidence-based CPGs for the management of severe TBI. The identified CPGs were screened for prehospital recommendations. Finally, an evaluation of the completeness and level of evidence for each of the identified recommendations was carried out. A review of the literature identified additional evidence. Designs of the retrieved publications were considered and classified according to the GRADE levels of evidence. RESULTS: This study identified 12 current CPGs for the management of patients after traumatic brain injury. Of these, twenty-one prehospital recommendations were selected. Only a few CPGs made recommendations on temperature management and ventilation patterns. Statements on prehospital transport and advanced airway management were common to all of the guidelines. Statements on initial treatment demonstrated the greatest variability. The literature review identified several relevant publications not included in the CPGs even after we controlled for the indicated time-intervals of their literature search. In addition, evidence from more recent trials published outside the search-interval of the clinical practice guidelines was found. CONCLUSIONS: The use of current guidelines on traumatic brain injury will not always facilitate decisions about best or most appropriate practice for prehospital practitioners. The amount of recommended prehospital interventions varied considerably, and there was large content variation in prehospital recommendations in these guidelines. Not all evidence was taken into account and not all CPGs were up-to-date.
Authors: Eric Peter Thelin; David W Nelson; Juho Vehviläinen; Harriet Nyström; Riku Kivisaari; Jari Siironen; Mikael Svensson; Markus B Skrifvars; Bo-Michael Bellander; Rahul Raj Journal: PLoS Med Date: 2017-08-03 Impact factor: 11.069
Authors: Michael McCaul; Mike Clarke; Stevan R Bruijns; Peter W Hodkinson; Ben de Waal; Jennifer Pigoga; Lee A Wallis; Taryn Young Journal: Afr J Emerg Med Date: 2018-10-24
Authors: Rebecka Rubenson Wahlin; David W Nelson; Bo-Michael Bellander; Mikael Svensson; Adel Helmy; Eric Peter Thelin Journal: Front Neurol Date: 2018-04-10 Impact factor: 4.003
Authors: Charlie Aletta Sewalt; Benjamin Yaël Gravesteijn; David Menon; Hester Floor Lingsma; Andrew I R Maas; Nino Stocchetti; Esmee Venema; Fiona E Lecky Journal: Scand J Trauma Resusc Emerg Med Date: 2021-08-04 Impact factor: 2.953