Assessing Swedish guidelines for prehospital bleeding control: a cross-sectional appraisal using AGREE II

Background High-quality clinical practice guidelines are essential for safe and consistent prehospital bleeding control, particularly in settings with variable geography and transport times. This study appraised the methodological quality of Swedish regional prehospital guidelines for traumatic external haemorrhage using the AGREE II instrument. Methods This cross-sectional study included clinical practice guidelines requested from all 21 Swedish healthcare regions. Guideline quality was assessed independently by two appraisers using AGREE II, which evaluates 23 items across six domains. Domain scores were calculated as percentages of the maximum possible score. Results Complete responses were obtained from 15 of 21 regions. Overall methodological quality was low across the included guidelines. The highest median domain score was observed for clarity of presentation, whereas rigour of development, stakeholder involvement, applicability, and editorial independence scored poorly. Most guidelines lacked explicit descriptions of evidence search strategies, criteria for selecting evidence, links between recommendations and supporting evidence, update procedures, and declarations of editorial independence. Conclusions Swedish regional prehospital guidelines for traumatic external bleeding control showed limited methodological quality when assessed using AGREE II. Future guideline development should prioritise transparent evidence linkage, multidisciplinary stakeholder involvement, clear implementation considerations, scheduled updating, and adaptation to regional differences in transport and evacuation times. Trial registration Not applicable.