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Systematic review and appraisal of clinical practice guidelines for sports-related concussion
ESSKA Academy. Dayton S. Nov 8, 2019; 284428; epESMA-15
Mr. Steven Dayton
Mr. Steven Dayton
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Abstract
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Introduction: Clinical practice guidelines (CPGs) relating to concussion management are published by various health care specialties. A systematic analysis can help identify high quality CPGs for clinical use by sports medicine physicians.
Objectives: The purpose of this study is to systematically identify and appraise relevant CPGs related to sports related concussion (SRC).
Aims: This is the first study to systematically compile all relevant CPGs related to sports related concussions and evaluate their methodologic quality. It can help to inform sports medicine physicians of high-quality guidelines from multiple disciplines for the care of the concussed athlete.
Methods: Predetermined selection criteria were utilized by 2 reviewers who independently identified published CPGs before November 1, 2018. CPGs were excluded if they focused only on pediatric patients or their scope was greater than concussion in the setting of sports. The remaining guidelines were analyzed by 5 independent reviewers with different clinical backgrounds using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Guidelines were deficient if they earned scores less than 50%. The Spearman correlation coefficient was used to assess interobserver agreement between the evaluators. Scores were compared by publishing institution and health care discipline using Kruskal-Wallis tests.
Results: Seven CPGs met the inclusion criteria. Interobserver agreement was strong and mean scores between surgical trainees (124.5) and board certified surgeons (125.9) were not statistically different. Guideline quality was variable but not deficient (>50%), except regarding “editorial independence”. No statistical difference was found between guidelines from different publishing institutions. Additionally, no statistical difference was found between guidelines of different health care professionals.
Conclusions: Overall, CPG quality was variable but not deficient, except for the domain of editorial independence. Bias due to poor editorial independence is a concern, particularly in CPGs published by non-physicians. To improve future guideline quality, future CPGs should consider the breadth of evidence from a variety of health care disciplines to publish more thorough guidelines for management of concussion.
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