| Quality and consistency of guidelines for the management of mild traumatic brain injury in the emergency department. | |
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MedLine Citation:
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PMID: 21843224 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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ACADEMIC EMERGENCY MEDICINE 2011; 18:880-889 © 2011 by the Society for Academic Emergency Medicine ABSTRACT: Objectives: The objective was to provide an overview of the recommendations and quality of evidence-based clinical practice guidelines (CPGs) for the emergency management of mild traumatic brain injury (mTBI), with a view to informing best practice and improving the consistency of recommendations. Methods: Electronic searches of health databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO), CPG clearinghouse websites, CPG developer websites, and Internet search engines up to January 2010 were conducted. CPGs were included if 1) they were published in English and freely accessible, 2) their scope included the management of mTBI in the emergency department (ED), 3) the date of last search was within the past 10 years (2000 onward), 4) systematic methods were used to search for evidence, and 5) there was an explicit link between the recommendations and the supporting evidence. Four authors independently assessed the quality of the included CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. The authors extracted and categorized recommendations according to initial clinical assessment, imaging, management, observation, discharge planning, and patient information and follow-up. Results: The search identified 18 potential CPGs, of which six met the inclusion criteria. The included CPGs varied in scope, target population, size, and guideline development processes. Four CPGs were assessed as "strongly recommended." The majority of CPGs did not provide information about the level of stakeholder involvement (mean AGREE standardized domain score = 57%, range = 25% to 81%), nor did they address the organizational/cost implications of applying the recommendations or provide criteria for monitoring and review of recommendations in practice (mean AGREE standardized domain score = 46.6%, range = 19% to 94%). Recommendations were mostly consistent in terms of the use of the Glasgow Coma Scale (GCS) score (adult and pediatric) to assess the level of consciousness, initial assessment criteria, the use of computed tomography (CT) scanning as imaging investigation of choice, and the provision of patient information. The CPGs defined mTBI in a variety of ways and described different rules to determine the need for CT scanning and therefore used different criteria to identify high-risk patients. Conclusions: Higher-quality CPGs for mTBI are consistent in their recommendations about assessment, imaging, and provision of patient information. There is not, however, an agreed definition of mTBI, and the quality of future CPGs could be improved with better reporting of stakeholder involvement, procedures for updating, and greater consideration of the applicability of the recommendations (cost implications, monitoring procedures). Nevertheless, guideline developers may benefit from adapting existing CPGs to their local context rather than investing in developing CPGs de novo. |
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Authors:
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Emma J Tavender; Marije Bosch; Sally Green; Denise O'Connor; Veronica Pitt; Kate Phillips; Peter Bragge; Russell L Gruen |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 18 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-08-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 880-9 Citation Subset: IM |
Copyright Information:
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© 2011 by the Society for Academic Emergency Medicine. |
Affiliation:
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From the National Trauma Research Institute, The Alfred Hospital/Department of Surgery (EJT, VP, PB, RLG), and the School of Public Health and Preventive Medicine (MB, SG, DO, KP), Monash University, Melbourne, Victoria, Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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