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Clinical Practice Guideline Recommendations in Pediatric Orthopaedic Injury: A Systematic Review
Lynne Moore1,2, Justin Drager3, Gabrielle Freire4
1Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus).
Insights
This study reviewed pediatric orthopaedic injury care guidelines, finding 7 high-quality clinical practice guidelines (CPGs). Clinicians can use these synthesized recommendations, but future CPGs need stakeholder input and implementation strategies.
Area of Science:
- Orthopaedic Surgery
- Pediatric Care
- Evidence-Based Medicine
Background:
- Adherence to pediatric orthopaedic injury care recommendations is inconsistent.
- Knowledge gaps, recommendation heterogeneity, and quality concerns may contribute to poor adherence.
- Clinical practice guidelines (CPGs) are crucial for standardizing care.
Purpose of the Study:
- To identify CPGs for pediatric orthopaedic injury care.
- To appraise the quality of identified CPGs.
- To synthesize evidence quality and recommendation strength from high-quality CPGs.
Main Methods:
- Systematic search of multiple databases and clinical organization websites.
- Inclusion of CPGs for pediatric orthopaedic injuries developed in the last 15 years.
- Quality appraisal using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool and synthesis using the GRADE Evidence-to-Decision framework.
Main Results:
- 13 CPGs were eligible, with 7 rated as high quality.
- Key weaknesses identified were lack of stakeholder involvement and applicability.
- 53 recommendations were extracted, with 19 based on moderate or high-quality evidence.
Conclusions:
- A synthesis of recommendations from high-quality CPGs is provided for clinical decision-making.
- Future CPG development should prioritize stakeholder partnerships and implementation strategies.
- There is a need for more rigorous research in pediatric orthopaedic trauma care.
Background:
Lack of adherence to recommendations on pediatric orthopaedic injury care may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aimed to identify CPGs for pediatric orthopaedic injury care, appraise their quality, and synthesize the quality of evidence and the strength of associated recommendations.
Methods:
We searched Medline, Embase, Cochrane CENTRAL, Web of Science and websites of clinical organizations. CPGs including at least one recommendation targeting pediatric orthopaedic injury populations on any diagnostic or therapeutic intervention developed in the last 15 years were eligible. Pairs of reviewers independently extracted data and evaluated CPG quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. We synthesized recommendations from high-quality CPGs using a recommendations matrix based on the GRADE Evidence-to-Decision framework.
Results:
We included 13 eligible CPGs, of which 7 were rated high quality. Lack of stakeholder involvement and applicability (i.e., implementation strategies) were identified as weaknesses. We extracted 53 recommendations of which 19 were based on moderate or high-quality evidence.
Conclusions:
We provide a synthesis of recommendations from high-quality CPGs that can be used by clinicians to guide treatment decisions. Future CPGs should aim to use a partnership approach with all key stakeholders and provide strategies to facilitate implementation. This study also highlights the need for more rigorous research on pediatric orthopaedic trauma.
Level Of Evidence:
Level II-therapeutic study.
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