Abstract：
To systematically review clinical practice guidelines (CPGs) for pediatric multisystem trauma, appraise their quality, synthesize the strength of recommendations and quality of evidence, and identify knowledge gaps.
Traumatic injuries are the leading cause of death and disability in children, who require a specific approach to injury care. Difficulties integrating CPG recommendations may cause observed practice and outcome variation in pediatric trauma care.
We conducted a systematic review using Medline, Embase, Cochrane Library, Web of Science, ClinicalTrials, and grey literature, from January 2007 to November 2022. We included CPGs targeting pediatric multisystem trauma with recommendations on any acute care diagnostic or therapeutic interventions. Pairs of reviewers independently screened articles, extracted data, and evaluated the quality of CPGs using \"Appraisal of Guidelines, Research, and Evaluation II.\"
We reviewed 19 CPGs, and 11 were considered high quality. Lack of stakeholder engagement and implementation strategies were weaknesses in guideline development. We extracted 64 recommendations: 6 (9%) on trauma readiness and patient transfer, 24 (38%) on resuscitation, 22 (34%) on diagnostic imaging, 3 (5%) on pain management, 6 (9%) on ongoing inpatient care, and 3 (5%) on patient and family support. Forty-two (66%) recommendations were strong or moderate, but only 5 (8%) were based on high-quality evidence. We did not identify recommendations on trauma survey assessment, spinal motion restriction, inpatient rehabilitation, mental health management, or discharge planning.
We identified 5 recommendations for pediatric multisystem trauma with high-quality evidence. Organizations could improve CPGs by engaging all relevant stakeholders and considering barriers to implementation. There is a need for robust pediatric trauma research, to support recommendations.
Traumatic injuries are the leading cause of death and disability in children, who require a specific approach to injury care. Difficulties integrating CPG recommendations may cause observed practice and outcome variation in pediatric trauma care.
We conducted a systematic review using Medline, Embase, Cochrane Library, Web of Science, ClinicalTrials, and grey literature, from January 2007 to November 2022. We included CPGs targeting pediatric multisystem trauma with recommendations on any acute care diagnostic or therapeutic interventions. Pairs of reviewers independently screened articles, extracted data, and evaluated the quality of CPGs using \"Appraisal of Guidelines, Research, and Evaluation II.\"
We reviewed 19 CPGs, and 11 were considered high quality. Lack of stakeholder engagement and implementation strategies were weaknesses in guideline development. We extracted 64 recommendations: 6 (9%) on trauma readiness and patient transfer, 24 (38%) on resuscitation, 22 (34%) on diagnostic imaging, 3 (5%) on pain management, 6 (9%) on ongoing inpatient care, and 3 (5%) on patient and family support. Forty-two (66%) recommendations were strong or moderate, but only 5 (8%) were based on high-quality evidence. We did not identify recommendations on trauma survey assessment, spinal motion restriction, inpatient rehabilitation, mental health management, or discharge planning.
We identified 5 recommendations for pediatric multisystem trauma with high-quality evidence. Organizations could improve CPGs by engaging all relevant stakeholders and considering barriers to implementation. There is a need for robust pediatric trauma research, to support recommendations.
摘要：
目的：系统回顾儿科多系统创伤的临床实践指南（CPG），评估他们的质量，综合建议的强度和证据的质量，并确定知识差距。
背景：创伤是儿童死亡和残疾的主要原因，他们需要特定的伤害护理方法。整合CPG建议的困难可能会导致小儿创伤护理中观察到的实践和结果差异。
方法：我们使用Medline进行了系统评价，Embase,科克伦图书馆,WebofScience,临床试验和灰色文献，从2007年1月到2022年11月。我们纳入了针对小儿多系统创伤的CPG，并对任何急性护理诊断或治疗干预措施提出了建议。成对的审稿人独立筛选文章，提取的数据，并使用AGREEII评估CPG的质量。
结果：我们回顾了19个CPG，和11被认为是高质量的。缺乏利益攸关方的参与和实施战略是准则制定中的弱点。我们提取了64条建议：6条（9%）关于创伤准备和病人转移，24（38%）复苏，22（34%）诊断成像，3（5%）疼痛管理，6（9％）的持续住院护理和3（5％）的患者和家庭支持。42项(66%)建议为强或中,但只有5（8％）基于高质量的证据。我们没有确定创伤调查评估的建议，脊柱运动限制,住院康复,心理健康管理,或出院计划。
结论：我们以高质量的证据确定了5项关于小儿多系统创伤的建议。组织可以通过让所有相关利益相关者参与并考虑实施障碍来改善CPG。需要强有力的儿科创伤研究，支持建议。
背景：创伤是儿童死亡和残疾的主要原因，他们需要特定的伤害护理方法。整合CPG建议的困难可能会导致小儿创伤护理中观察到的实践和结果差异。
方法：我们使用Medline进行了系统评价，Embase,科克伦图书馆,WebofScience,临床试验和灰色文献，从2007年1月到2022年11月。我们纳入了针对小儿多系统创伤的CPG，并对任何急性护理诊断或治疗干预措施提出了建议。成对的审稿人独立筛选文章，提取的数据，并使用AGREEII评估CPG的质量。
结果：我们回顾了19个CPG，和11被认为是高质量的。缺乏利益攸关方的参与和实施战略是准则制定中的弱点。我们提取了64条建议：6条（9%）关于创伤准备和病人转移，24（38%）复苏，22（34%）诊断成像，3（5%）疼痛管理，6（9％）的持续住院护理和3（5％）的患者和家庭支持。42项(66%)建议为强或中,但只有5（8％）基于高质量的证据。我们没有确定创伤调查评估的建议，脊柱运动限制,住院康复,心理健康管理,或出院计划。
结论：我们以高质量的证据确定了5项关于小儿多系统创伤的建议。组织可以通过让所有相关利益相关者参与并考虑实施障碍来改善CPG。需要强有力的儿科创伤研究，支持建议。
