A Systematic Review of the Current State of Trauma Clinical Practice Guidelines in the United States: Timeliness, Relevance, Accessibility, Quality, and Equity
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Background
Clinical Practice Guidance (CPGs) are essential for standardizing trauma care and improving patient outcomes. Trauma clinical guidance in the United States often lacks coordination, timely updates, and applicability beyond academic Level I centers. This systematic review assesses the current state of trauma-related CPGs in the United States by examining their timeliness, relevance, accessibility, quality, and equity.
Methods
A systematic database search identified 1766 studies, of which 65 met inclusion criteria. We searched eight databases and 28 trauma societies’ websites for CPGs published between 2016 and 2024. We utilized MeSH terms to gather protocols, guidelines, and reviews, and evaluated their quality using the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) criteria. Logistic regression was then used to analyze predictive factors for high-quality guideline creation.
Results
Most authors (96.7%) were affiliated with a Level I trauma center, with significant contributions from Trauma Region 3. Fifty-five (84.6%) CPGs were sponsored by professional societies, most commonly by the Eastern Association for the Surgery of Trauma (EAST). Eighty-three percent of included guidance was open access without requiring registration. The average cost of the remaining CPGs was 46.16 USD (SD 14.21). The mean NEATS score was 4.02 ± 1.01. Logistic regression showed that high-quality guidance was significantly associated with the inclusion of methodological experts (p=0.03) and funding disclosures (p=0.04).
Conclusions
Trauma CPGs are primarily produced by academic institutions affiliated with Level I trauma centers and are commonly endorsed by a professional trauma society. While most guidance is open access, there is an opportunity to enhance their quality, accessibility, and applicability, particularly in lower-resourced settings.
