Quality assessment of clinical practice guidelines for adaptation in burn injury

Kis, E.; Szegesdi, I.; Dobos, E.; Nagy, E.; Boda, K.; Kemény, L.; Horvath, A.R.

doi:10.1016/j.burns.2009.08.017

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Volume 36, Issue 5 , Pages 606-615, August 2010

Quality assessment of clinical practice guidelines for adaptation in burn injury

E. Kis
- Burn and Plastic Surgery Unit, Department of Dermatology and Allergology, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, 6-8 Korányi fasor, Szeged, H-6720, Hungary
- Corresponding author. Tel.: +36 30 9735711.
I. Szegesdi
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, Szeged, Hungary
E. Dobos
- TUDOR Hungarian EBM Network, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, Szeged, Hungary
E. Nagy
- Department of Clinical Chemistry, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, Szeged, Hungary
K. Boda
- Department of Medical Informatics, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, Szeged, Hungary
L. Kemény
- Burn and Plastic Surgery Unit, Department of Dermatology and Allergology, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, 6-8 Korányi fasor, Szeged, H-6720, Hungary
A.R. Horvath
- Department of Clinical Chemistry, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, Szeged, Hungary

Accepted 21 August 2009.

Abstract

Objectives

A number of clinical practice guidelines (CPGs) are available for managing burn injury patients but clinical practice is highly variable. We report the first steps to trans-contextual adaptation of international burn CPGs to local settings.

Methods

Key clinical topics and questions to be covered in the final guideline were defined and prioritized. Systematic search between 1990 and 2008 retrieved 546 citations, of which 24 were CPGs on the general and intensive care of burn patients. Assessment of the clinical content of CPGs was carried out. Methodological quality of CPGs was evaluated using the AGREE instrument.

Results

Of the 24 CPGs evaluated, 10 (42%) were evidence-based. All major burn topics were covered by at least one CPG, but no single CPG addressed all areas important in terms of outcomes. According to the AGREE criteria, 2 CPGs (8%) were strongly recommended, 14 with provisos or alterations (58%) and the rest were not recommended for adaptation.

Conclusions

Although existing CPGs for the management of burn may accurately reflect agreed clinical practice, most performed poorly when evaluated for methodological quality. Future CPG efforts addressing these methodological shortcomings would add substantially to the improved management of burned patients.

Abbreviations: AGREE, Appraisal of Guidelines for Research and Evaluation, CB, consensus-based, CPG, clinical practice guideline, EB, evidence-based

Keywords: Burn injury, Evidence-based medicine, Guidelines, Guideline adaptation, Intensive care, Quality