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Updated: Sep 17, 2025

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
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A framework for the development and implementation of open trauma guidelines: A Delphi consensus validation.

Juan Enrique Berner1, Carl Heneghan2, Jagdeep Nanchahal3

  • 1Kellogg College, University of Oxford, Oxford, United Kingdom; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, United States of America.

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|June 27, 2025
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Summary
This summary is machine-generated.

This study developed and validated a framework to help implement clinical guidelines for open lower limb fractures in countries lacking them. The framework, validated by expert surgeons, aids in managing these severe injuries and improving patient outcomes.

Keywords:
Delphi studyFrameworkImplementation scienceOpen fractures

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Area of Science:

  • Traumatology
  • Implementation Science
  • Clinical Guideline Development

Background:

  • Lower limb open fractures are severe injuries with potential long-term complications.
  • Clinical guidelines expedite treatment and improve outcomes for these fractures.
  • Few countries currently have established guidelines for managing open lower limb fractures.

Purpose of the Study:

  • To develop and validate a framework for introducing clinical guidelines for open lower limb fractures in settings without existing guidelines.

Main Methods:

  • A framework was designed using qualitative analysis from the Limitations to the Implementation of Open Trauma Guidelines (LINEAGE) study.
  • The framework comprised 4 clusters: clinician, team, health, and cultural factors.
  • A modified Delphi study with an international panel of 43 orthopaedic and plastic surgeons validated the framework through 3 rounds.

Main Results:

  • 11 out of 12 statements in the Delphi questionnaire achieved validation consensus.
  • One statement did not reach consensus and was removed from the framework.
  • The validated framework provides a structured approach for guideline implementation.

Conclusions:

  • Frameworks are valuable tools in implementation science for managing complexity and strategizing improvements.
  • This study presents the first validated framework specifically for developing and implementing open fracture guidelines.