Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov-Dec;43(10):e790-e797.
doi: 10.1097/BPO.0000000000002496. Epub 2023 Aug 22.

Clinical Practice Guideline Recommendations in Pediatric Orthopaedic Injury: A Systematic Review

Lynne Moore  1   2 , Justin Drager  3 , Gabrielle Freire  4 , Natalie Yanchar  5 , Anna N Miller  6 , Anis Ben Abdel  1 , Mélanie Bérubé  1   7 , Pier-Alexandre Tardif  1 , Janyce Gnanvi  1 , Henry T Stelfox  8 , Marianne Beaudin  9 , Antonia Stang  10 , Suzanne Beno  11 , Matthew Weiss  12 , Melanie Labrosse  13 , Roger Zemek  14 , Isabelle J Gagnon  15 , Emilie Beaulieu  12 , Simon Berthelot  1 , Terry Klassen  16 , Alexis F Turgeon  1   2   17 , François Lauzier  1   2   17 , Belinda Gabbe  18 , Sasha Carsen  19
Affiliations

Clinical Practice Guideline Recommendations in Pediatric Orthopaedic Injury: A Systematic Review

Lynne Moore et al. J Pediatr Orthop. 2023 Nov-Dec.

Abstract

Background: Lack of adherence to recommendations on pediatric orthopaedic injury care may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aimed to identify CPGs for pediatric orthopaedic injury care, appraise their quality, and synthesize the quality of evidence and the strength of associated recommendations.

Methods: We searched Medline, Embase, Cochrane CENTRAL, Web of Science and websites of clinical organizations. CPGs including at least one recommendation targeting pediatric orthopaedic injury populations on any diagnostic or therapeutic intervention developed in the last 15 years were eligible. Pairs of reviewers independently extracted data and evaluated CPG quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. We synthesized recommendations from high-quality CPGs using a recommendations matrix based on the GRADE Evidence-to-Decision framework.

Results: We included 13 eligible CPGs, of which 7 were rated high quality. Lack of stakeholder involvement and applicability (i.e., implementation strategies) were identified as weaknesses. We extracted 53 recommendations of which 19 were based on moderate or high-quality evidence.

Conclusions: We provide a synthesis of recommendations from high-quality CPGs that can be used by clinicians to guide treatment decisions. Future CPGs should aim to use a partnership approach with all key stakeholders and provide strategies to facilitate implementation. This study also highlights the need for more rigorous research on pediatric orthopaedic trauma.

Level of evidence: Level II-therapeutic study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Naranje SM, Erali RA, Warner WC Jr, et al. Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 2016;36:e45–e48.
    1. Oliver J, Avraham J, Frangos S, et al. The epidemiology of inpatient pediatric trauma in United States hospitals 2000 to 2011. J Pediatr Surg. 2018;53:758–764.
    1. Pandya NK, Upasani VV, Kulkarni VA. The pediatric polytrauma patient: current concepts. J Am Acad Orthop Surg. 2013;21:170–179.
    1. Kim WJ, Hind J, Ashwood N. Assessing compliance to national guidelines for pediatric wrist and ankle fractures in a district general hospital. Cureus. 2021;13:e19374.
    1. Brandt AM, Wally MK, Casey VF, et al. Appropriate use criteria for treatment of pediatric supracondylar humerus fractures with vascular injury: do our hospital practice patterns agree with current recommendations? J Pediatr Orthop. 2020;40:549–55.

Publication types