Recommendations for Improving the Quality of Prehospital Evidence-Based Guidelines

Figures & data

Figure 1. Definition of a prehospital evidence-based guideline.

Table 1. Tools and criteria used to evaluate evidence synthesis and guidelines.

Tools to evaluate guidelines
ADAPTE process
Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument
German Instrument for Methodological Guideline Appraisal (DELBI)
GuideLine Implementability Appraisal (GLIA)
National Academy of Medicine Criteria for Clinical Practice Guidelines
Tools to evaluate evidence synthesis
Assessing the Methodological Quality of Systematic Reviews (AMSTAR)
International Network of Agencies for Health Technology Assessment (INAHTA) checklist
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

Table 2. Adapted National Academy of Medicine criteria for clinical practice guidelines.

Criteria	Description
1. Systematically developed recommendations	The clinical practice guideline contains systematically developed statements including recommendations intended to optimize patient care and assist physicians and/or other health care practitioners and patients to make decisions about appropriate health care for specific clinical circumstances.
2. By an association or similar organization	The clinical practice guideline was produced under the auspices of a medical specialty association; relevant professional society; public or private organization; government agency at the Federal, State, or local level; or health care organization or plan. A clinical practice guideline developed and issued by an individual(s) not officially sponsored or supported by one of the above types of organizations does not meet the criteria.
3. Systematic review	The clinical practice guideline is based on a systematic review of evidence as demonstrated by documentation of each of the following features in the clinical practice guideline or its supporting documents.
a. Statement	An explicit statement that the clinical practice guideline was based on a systematic review.
b. Search strategy	A description of the search strategy that includes: - A listing of database(s) searched, - A summary of search terms used, and - The specific time period covered by the literature search including the beginning date (month/year) and end date (month/year)
c. Study selection	A description of the study selection that includes: - The number of studies identified, - The number of studies included, and - A summary of inclusion and exclusion criteria.
d. Synthesis of evidence	A synthesis of evidence from the selected studies, e.g., a detailed description or evidence tables.
e. Summary of evidence synthesis	A summary of the evidence synthesis (see 3d above) included in the guideline that relates the evidence to the recommendations, e.g., a descriptive summary or summary tables.
4. Assessment of benefits/harms and alternative care options	The clinical practice guideline or its supporting documents contain an assessment of the benefits and harms of recommended care and alternative care options.
5. English and to the public	The full text guideline is available in English to the public upon request (for free, or for a fee).
6. Current	The guideline is current and the most recent version.

Reproduced from Turner et al. (13).

Table 3. Appraisal of guidelines for research and evaluation (AGREE) II instrument.

Domain	No.	Item
1. Scope and purpose	1	The overall objective(s) of the guideline is (are) specifically described.
	2	The health question(s) covered by the guideline is (are) specifically described.
	3	The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described.
2. Stakeholder involvement	4	The guideline development group includes individuals from all relevant professional groups.
	5	The views and preferences of the target population (patients, public, etc.) have been sought.
	6	The target users of the guideline are clearly defined.
3. Rigor of development	7	Systematic methods were used to search for evidence.
	8	The criteria for selecting the evidence are clearly described.
	9	The strengths and limitations of the body of evidence are clearly described.
	10	The methods for formulating the recommendations are clearly described.
	11	The health benefits, side effects, and risks have been considered in formulating the recommendations.
	12	There is an explicit link between the recommendations and the supporting evidence.
	13	The guideline has been externally reviewed by experts prior to its publication.
	14	A procedure for updating the guideline is provided.
4. Clarity of presentation	15	The recommendations are specific and unambiguous.
	16	The different options for management of the condition or health issue are clearly presented.
	17	Key recommendations are easily identifiable.
5. Applicability	18	The guideline describes facilitators and barriers to its application.
	19	The guideline provides advice and/or tools on how the recommendations can be put into practice.
	20	The potential resource implications of applying the recommendations have been considered.
	21	The guideline presents monitoring and/or auditing criteria.
6. Editorial independence	22	The views of the funding body have not influenced the content of the guideline.
	23	Competing interests of guideline development group members have been recorded and addressed.

Reproduced from Turner et al. (13).

Turner S, Lang ES, Brown K, Franke J, Workun-Hill M, Jackson C, Roberts L, Leyton C, Bulger EM, Censullo EM, et al. Systematic review of evidence-based guidelines for prehospital care. Prehosp Emerg Care. 2021;25(2):221–34. doi:10.1080/10903127.2020.1754978

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