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CAA Congress 2024: Michelle Thomson - Clinical Practice Guidelines in prehospital
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Background: Quality, evidence-based clinical practice guidelines (CPGs) support clinicians and optimize patient care. Not all CPGs meet rigorous evidence-based standards. Evaluating pain management CPGs, their quality, and adaptability into practice is crucial given pain’s frequent occurrence in ambulance service.
Objective: This review examines prehospital pain management CPGs to identify recommendations that can be adopted or adapted into paramedic clinical practice. We also assess the methodological quality of these CPGs and their recommendations.
Methods: This review combined the PICAR framework, JBI umbrella and scoping review methodology. 12 databases, Google Scholar and Google were searched, and prehospital organizations were contacted. Methodological rigor and clinical credibility were assessed using AGREE II and AGREE-REX. Characteristics of both CPGs and recommendations were extracted.
Results: From 1103 studies reviewed, 25 CPGs met criteria, including 11 from Australia and New Zealand, three from the USA, four from Canada, and one each from South Africa, Iran, Qatar, Ireland, Europe, and the UK. AGREE II assessment revealed that less than half scored above 60%, with only 9 following a recognized methodology. Despite this, some high-quality CPGs for prehospital pain management were found. Recommendations on pharmacological and non-pharmacological approaches varied in specificity and applicability, as did pain assessment strategies, with differing levels of detail.
Conclusion: This study reveals quality and methodological variations in pre-hospital pain CPGs, with many lacking clear methodological frameworks. Identifying areas for improvement enhances CPG reliability and clinical utility. Standardizing guideline development globally in prehospital settings is necessary to boost patient outcomes and evidence-based healthcare delivery.
Objective: This review examines prehospital pain management CPGs to identify recommendations that can be adopted or adapted into paramedic clinical practice. We also assess the methodological quality of these CPGs and their recommendations.
Methods: This review combined the PICAR framework, JBI umbrella and scoping review methodology. 12 databases, Google Scholar and Google were searched, and prehospital organizations were contacted. Methodological rigor and clinical credibility were assessed using AGREE II and AGREE-REX. Characteristics of both CPGs and recommendations were extracted.
Results: From 1103 studies reviewed, 25 CPGs met criteria, including 11 from Australia and New Zealand, three from the USA, four from Canada, and one each from South Africa, Iran, Qatar, Ireland, Europe, and the UK. AGREE II assessment revealed that less than half scored above 60%, with only 9 following a recognized methodology. Despite this, some high-quality CPGs for prehospital pain management were found. Recommendations on pharmacological and non-pharmacological approaches varied in specificity and applicability, as did pain assessment strategies, with differing levels of detail.
Conclusion: This study reveals quality and methodological variations in pre-hospital pain CPGs, with many lacking clear methodological frameworks. Identifying areas for improvement enhances CPG reliability and clinical utility. Standardizing guideline development globally in prehospital settings is necessary to boost patient outcomes and evidence-based healthcare delivery.
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