A framework for the development and implementation of open trauma guidelines: A Delphi consensus validation

IF 2 3区 医学 Q2 SURGERY
Juan Enrique Berner , Carl Heneghan , Jagdeep Nanchahal , Abhilash Jain
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引用次数: 0

Abstract

Introduction

Lower limb open fractures are severe injuries that can lead to long-term sequelae. Clinical guidelines for managing these patients are associated with expedited treatment and better outcomes. However, few countries have implemented guidelines for open lower limb fractures. The aim of this study was to develop and validate a framework for the introduction of clinical guidelines in settings that do not have one at present.

Methods

Using the qualitative analysis for the Limitations to the Implementation of Open Trauma Guidelines (LINEAGE) study, a framework proposal was designed. This included 4 clusters of inter-related concepts, including clinician, team, health and cultural factors. To validate this framework a modified Delphi study was devised. The elements of the framework were translated into 12 statements that were compiled in a Delphi questionnaire. A panel of orthopaedic and plastic surgeons was assembled to obtain structured feedback and assess the degree of consensus regarding the framework proposal.

Results

Using purposive sampling, 43 clinicians enrolled in an international expert panel, including 20 orthopaedic and 23 plastic surgeons based in countries with no guidelines at present. Following three Delphi rounds, 11 out of the 12 assessed statements achieved the threshold for validation. The single statement that did not reach consensus status was then removed from the framework.

Discussion

Frameworks are a well-described aid in implementation science, being able to describe complexity and propose strategies for improvement. We present the first validated framework for the development and implementation of open fracture guidelines.
开放性创伤指南的制定和实施框架:德尔菲共识验证
下肢开放性骨折是一种可导致长期后遗症的严重损伤。管理这些患者的临床指南与快速治疗和更好的结果相关。然而,很少有国家实施开放性下肢骨折的指南。本研究的目的是开发和验证一个框架,以便在目前没有临床指南的情况下引入临床指南。方法通过对开放性创伤指南(LINEAGE)研究实施局限性的定性分析,设计框架建议。这包括4组相互关联的概念,包括临床医生、团队、健康和文化因素。为了验证这一框架,设计了一个改进的德尔菲研究。框架的要素被翻译成12个陈述,汇编在德尔菲问卷中。一个骨科和整形外科医生小组被召集起来,以获得结构化的反馈,并评估关于框架建议的共识程度。结果采用有目的抽样的方法,43名临床医生加入了一个国际专家小组,其中包括20名骨科医生和23名来自目前没有指南的国家的整形外科医生。经过三轮德尔菲,12个评估语句中有11个达到了验证的阈值。未达成协商一致的单一声明随后从框架中删除。框架是实现科学中描述良好的辅助工具,能够描述复杂性并提出改进策略。我们为开放性骨折指南的制定和实施提出了第一个经过验证的框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
11.10%
发文量
578
审稿时长
3.5 months
期刊介绍: JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.
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