Article type
Abstract
Background
Quality, evidence-based clinical practice guidelines (CPGs) support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, evaluating pain management CPGs, their quality, and adaptability into practice is crucial.
Objective
This review aims to examine 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 (population, intervention, comparison, attributes of eligible CPGs, recommendations characteristics) framework and JBI umbrella and scoping review methodology. The search covered 12 databases, including PubMed, Embase, and specific CPG databases. Additionally, Google Scholar and Google were searched, and prehospital organizations were contacted. The AGREE II and AGREE-REX tools assessed methodological rigor and clinical credibility. Characteristics of both CPGs and recommendations were extracted.
Results
From 978 studies screened, 25 CPGs met inclusion criteria from various regions, including 11 from Australia and New Zealand, three from the USA, four from Canada, and single guidelines from South Africa, Iran, Qatar, Ireland, Europe, and the UK. Assessment using the AGREE II instrument showed that less than half of the CPGs scored 60% or above, with only 9 utilizing a recognized methodological framework. However, some high-quality CPGs for prehospital pain management were identified. Pharmacological and non-pharmacological recommendations varied in specificity and applicability across guidelines, and pain assessment strategies also varied, with differing levels of detail and clarity.
Conclusion
This study underscores the variability in quality and methodological rigor of pre-hospital pain CPGs across different regions, with a significant portion lacking clear methodological frameworks. By identifying areas for improvement in guideline development processes, this study paves the way for enhancing the reliability and utility of CPGs in clinical practice. Efforts to standardize guideline development practices in the prehospital setting globally are warranted to improve patient outcomes and promote evidence-based healthcare delivery.
Quality, evidence-based clinical practice guidelines (CPGs) support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, evaluating pain management CPGs, their quality, and adaptability into practice is crucial.
Objective
This review aims to examine 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 (population, intervention, comparison, attributes of eligible CPGs, recommendations characteristics) framework and JBI umbrella and scoping review methodology. The search covered 12 databases, including PubMed, Embase, and specific CPG databases. Additionally, Google Scholar and Google were searched, and prehospital organizations were contacted. The AGREE II and AGREE-REX tools assessed methodological rigor and clinical credibility. Characteristics of both CPGs and recommendations were extracted.
Results
From 978 studies screened, 25 CPGs met inclusion criteria from various regions, including 11 from Australia and New Zealand, three from the USA, four from Canada, and single guidelines from South Africa, Iran, Qatar, Ireland, Europe, and the UK. Assessment using the AGREE II instrument showed that less than half of the CPGs scored 60% or above, with only 9 utilizing a recognized methodological framework. However, some high-quality CPGs for prehospital pain management were identified. Pharmacological and non-pharmacological recommendations varied in specificity and applicability across guidelines, and pain assessment strategies also varied, with differing levels of detail and clarity.
Conclusion
This study underscores the variability in quality and methodological rigor of pre-hospital pain CPGs across different regions, with a significant portion lacking clear methodological frameworks. By identifying areas for improvement in guideline development processes, this study paves the way for enhancing the reliability and utility of CPGs in clinical practice. Efforts to standardize guideline development practices in the prehospital setting globally are warranted to improve patient outcomes and promote evidence-based healthcare delivery.