School of Medicine and Health Sciences Poster Presentations

Title

Is Prehospital Care Supported by Evidence-Based Guidelines? An Environmental Scan and Quality Appraisal using AGREE II

Document Type

Poster

Keywords

Emergency Medical Services (EMS); Prehospital Care; Guidelines

Publication Date

Spring 2017

Abstract

Introduction: The Institute of Medicine (IOM) has recommended that high-quality, evidence-based protocols be developed for emergency medical services (EMS). The National Association of EMS Physicians (NAEMSP) has outlined a strategy that will see this task fulfilled, consisting of multiple working groups focused on all aspects of guideline development and implementation. This group has been tasked with creating a needs analysis for evidence based guidelines in prehospital care. A first step, and our current objective is to catalogue and appraise current guidelines targeting EMS providers.

Methods: A systematic search of the literature was conducted in MEDLINE (1175), EMBASE (519), PubMed (14), Trip (416), and guidelines.gov (64) through May 1, 2016. Two independent reviewers screened titles for relevance to prehospital care, and then abstracts for essential guideline features, including a systematic review, a grading system, and an association between level of evidence and strength of recommendation. All disagreements were moderated by a third party. Citations meeting inclusion criteria were appraised with the AGREE II tool, which looks at six different domains of guideline quality, containing a total of 23 items rated from 1 to 7. Each guideline was appraised by three separate reviewers, and composite scores were calculated by averaging the scaled domain totals.

Results: After primary (kappa 97%) and secondary (kappa 93%) screening, 49 guidelines remained for full review. Three guidelines obtained a composite score of > 90%, the topics of which included aeromedical transport, analgesia in trauma, and resuscitation of avalanche victims. Two guidelines scored between 80% and 90%, the topics of which included stroke and pediatric seizure management. One guideline, splinting in an austere environment, scored between 70% and 80%. Nine guidelines scored between 60% and 70%, the topics of which included ischemic stroke, advanced cardiovascular life support, hemorrhage control, intubation, triage, hypothermia, and fibrinolytic use. Of the remaining guidelines, 14 scored between 50% and 60%, and 20 obtained a composite score of < 50%.

Conclusion: There are very few evidence-based guidelines in EMS. Of those that are published, the majority fail to meet established quality measures. The field of prehospital care would benefit from a wider breadth of rigorously developed clinical practice guidelines.

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Creative Commons License
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Poster to be presented at GW Annual Research Days 2017.

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Is Prehospital Care Supported by Evidence-Based Guidelines? An Environmental Scan and Quality Appraisal using AGREE II

Introduction: The Institute of Medicine (IOM) has recommended that high-quality, evidence-based protocols be developed for emergency medical services (EMS). The National Association of EMS Physicians (NAEMSP) has outlined a strategy that will see this task fulfilled, consisting of multiple working groups focused on all aspects of guideline development and implementation. This group has been tasked with creating a needs analysis for evidence based guidelines in prehospital care. A first step, and our current objective is to catalogue and appraise current guidelines targeting EMS providers.

Methods: A systematic search of the literature was conducted in MEDLINE (1175), EMBASE (519), PubMed (14), Trip (416), and guidelines.gov (64) through May 1, 2016. Two independent reviewers screened titles for relevance to prehospital care, and then abstracts for essential guideline features, including a systematic review, a grading system, and an association between level of evidence and strength of recommendation. All disagreements were moderated by a third party. Citations meeting inclusion criteria were appraised with the AGREE II tool, which looks at six different domains of guideline quality, containing a total of 23 items rated from 1 to 7. Each guideline was appraised by three separate reviewers, and composite scores were calculated by averaging the scaled domain totals.

Results: After primary (kappa 97%) and secondary (kappa 93%) screening, 49 guidelines remained for full review. Three guidelines obtained a composite score of > 90%, the topics of which included aeromedical transport, analgesia in trauma, and resuscitation of avalanche victims. Two guidelines scored between 80% and 90%, the topics of which included stroke and pediatric seizure management. One guideline, splinting in an austere environment, scored between 70% and 80%. Nine guidelines scored between 60% and 70%, the topics of which included ischemic stroke, advanced cardiovascular life support, hemorrhage control, intubation, triage, hypothermia, and fibrinolytic use. Of the remaining guidelines, 14 scored between 50% and 60%, and 20 obtained a composite score of < 50%.

Conclusion: There are very few evidence-based guidelines in EMS. Of those that are published, the majority fail to meet established quality measures. The field of prehospital care would benefit from a wider breadth of rigorously developed clinical practice guidelines.