Anesthesia Trauma Guidelines: A Systematic Review of Global Accessibility and Quality

This systematic review describes the available clinical practice guidelines (CPGs) for the anesthetic management of trauma and appraises the accessibility and quality of these resources. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted across 8 databases (MEDLINE, Embase, Web of Science, CABI Digital Library, Global Index Medicus, SciELO, Google Scholar, and National Institute for Health and Care Excellence) for guidelines from 2010 to 2023. Two independent reviewers assessed guideline eligibility and extracted data, which were audited by a third reviewer. Data regarding author demographics, accessibility, clinical topics, and quality were collected. The quality of guidelines was evaluated according to the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument. A total of 2426 articles were identified, of which 165 met eligibility criteria and were included. Guidelines were developed by 122 professional societies and authors from 51 countries. By region, Europe contributed with the most authors (61%), while Africa had the fewest (4%). Most CPGs were developed by authors from high-income countries (HIC) and only 12% had a first or last author from low- and middle-income countries (LMIC). The United States was the country with the most guideline authors. While 70% were open access, the average cost for paid access was US$36.61. Among the 8 languages identified, English was the most common. The most common topics were blood and fluid management, shock, and airway management. The overall quality of included guidelines was considered moderately high, with an average NEATS score of 3.13 of 5. Quality scores were lowest for involvement of patient perspectives, plans for updating, and presence of a methodologist. On logistic regression analysis, the involvement of a methodological expert was the only predictor of having a high-quality NEATS score, with no association observed with open accessibility, English language, society endorsement, first author from a HIC, or a multidisciplinary group composition. Though many countries and societies have contributed to the development of anesthesia CPGs for trauma, there has been a disproportionate lack of representation from LMICs, where the burden of trauma mortality is highest. In this study, we identify barriers to accessibility and areas for improving future guideline quality. We recommend ongoing efforts to incorporate perspectives from diverse settings and to increase the availability of high-quality, open-access guidelines to improve worldwide health outcomes in trauma.