Global emergency care clinical practice guidelines : a landscape analysis
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Introduction: An adaptive guideline development method, as opposed to a de novo guideline development, is
dependent on access to existing high-quality up-to-date clinical practice guidelines (CPGs). We described the
characteristics and quality of CPGs relevant to prehospital care worldwide, in order to strengthen guideline
development in low-resource settings for emergency care.
Methods: We conducted a descriptive study of a database of international CPGs relevant to emergency care
produced by the African Federation for Emergency Medicine (AFEM) CPG project in 2016. Guideline quality was
assessed with the AGREE II tool, independently and in duplicate. End-user documents such as protocols, care
pathways, and algorithms were excluded. Data were imported, managed, and analysed in STATA 14 and R.
Results: In total, 276 guidelines were included. Less than 2% of CPGs originated from low- and middle incomecountries
(LMICs); only 15% (n=38) of guidelines were prehospital specific, and there were no CPGs directly
applicable to prehospital care in LMICs. Most guidelines used de novo methods (58%, n=150) and were produced
by professional societies or associations (63%, n=164), with the minority developed by international
bodies (3%, n=7). National bodies, such as the National Institute for Health and Care Excellence (NICE) and the
Scottish Intercollegiate Guidelines Network (SIGN), produced higher quality guidelines when compared to international
guidelines, professional societies, and clinician/academic-produced guidelines. Guideline quality
varied across topics, subpopulations and producers. Resource-constrained guideline developers that cannot afford
de novo guideline development have access to an expanding pool of high-quality prehospital guidelines to
translate to their local setting.
Discussion: Although some high-quality CPGs exist relevant to emergency care, none directly address the needs
of prehospital care in LMICs, especially in Africa. Strengthening guideline development capacity, including
adaptive guideline development methods that use existing high-quality CPGs, is a priority.
Description
CITATION: McCaul, M., et al. 2018. Global emergency care clinical practice guidelines : a landscape analysis. African Journal of Emergency Medicine, 8(4):158-163, doi:10.1016/j.afjem.2018.09.002.
The original publication is available at https://www.sciencedirect.com
The original publication is available at https://www.sciencedirect.com
Keywords
Emergency medical services -- Practice, Ambulatory medical care -- Practice, Medical protocols
Citation
McCaul, M., et al. 2018. Global emergency care clinical practice guidelines : a landscape analysis. African Journal of Emergency Medicine, 8(4):158-163, doi:10.1016/j.afjem.2018.09.002