Developing appropriateness criteria for arterial catheters in adult intensive care unit patients

The aim of this study was to describe the methodological development of appropriate use criteria for arterial catheter use in adult intensive care units using the RAND Corporation/University of California, Los Angeles (RAND/UCLA) Appropriateness Method.

This methods paper reports the prespecified development phase of an appropriateness study. The RAND/UCLA Appropriateness Method was applied in sequential phases, including defining scope and key terms, synthesising evidence through a literature review and national survey, developing clinical indications, and rating indications across two rounds by an interdisciplinary expert panel. Panel members had expertise in arterial catheter insertion and management across intensive care, anaesthesiology, emergency medicine, infectious diseases, critical care nursing, and clinical and tertiary intensive care education. Clinical indications were iteratively developed based on common clinical scenarios, anticipated uses, practice guidelines, and available evidence on efficacy and safety. Each indication was rated on a 9-point scale (1 = harms outweigh benefits; 9 = benefits outweigh harms) and classified as appropriate (median: 7-9 without disagreement), uncertain/neutral (median: 4-6 or any median with disagreement), or inappropriate (median: 1-3 without disagreement). Disagreement was assessed using the Interpercentile Range Adjusted for Symmetry method.

The RAND/UCLA Appropriateness Method provides a structured, transparent, and reproducible approach for developing appropriate use criteria for arterial catheters in adult intensive care. The final appropriateness ratings and clinical recommendations derived from this process are reported separately.