Burn and Plastic Surgery Unit, Department of Dermatology and Allergology, University of Szeged, Medical Faculty, Albert Szent-Györgyi Clinical Center, 6-8 Korányi fasor, Szeged, Hungary.
Burns. 2010 Aug;36(5):606-15. doi: 10.1016/j.burns.2009.08.017. Epub 2009 Dec 22.
A number of clinical practice guidelines (CPGs) are available for managing burn injury patients but clinical practice is highly variable. We report the first steps to trans-contextual adaptation of international burn CPGs to local settings.
Key clinical topics and questions to be covered in the final guideline were defined and prioritized. Systematic search between 1990 and 2008 retrieved 546 citations, of which 24 were CPGs on the general and intensive care of burn patients. Assessment of the clinical content of CPGs was carried out. Methodological quality of CPGs was evaluated using the AGREE instrument.
Of the 24 CPGs evaluated, 10 (42%) were evidence-based. All major burn topics were covered by at least one CPG, but no single CPG addressed all areas important in terms of outcomes. According to the AGREE criteria, 2 CPGs (8%) were strongly recommended, 14 with provisos or alterations (58%) and the rest were not recommended for adaptation.
Although existing CPGs for the management of burn may accurately reflect agreed clinical practice, most performed poorly when evaluated for methodological quality. Future CPG efforts addressing these methodological shortcomings would add substantially to the improved management of burned patients.
有许多临床实践指南（CPGs）可用于管理烧伤患者，但临床实践差异很大。我们报告了将国际烧伤 CPG 转化为当地环境的第一步。
确定并优先考虑最终指南中要涵盖的关键临床主题和问题。1990 年至 2008 年的系统搜索共检索到 546 条引文，其中 24 条是关于烧伤患者一般和重症监护的 CPG。对 CPG 的临床内容进行了评估。使用 AGREE 工具评估 CPG 的方法学质量。
在所评估的 24 项 CPG 中，有 10 项（42%）是基于证据的。所有主要烧伤主题都至少被一项 CPG 涵盖，但没有一项 CPG 涵盖了所有与结果相关的重要领域。根据 AGREE 标准，有 2 项 CPG（8%）被强烈推荐，有 14 项附有条件或变更（58%），其余的则不建议改编。
尽管现有的烧伤管理 CPG 可能准确反映了商定的临床实践，但在评估方法学质量时，大多数 CPG 的表现都很差。未来解决这些方法学缺陷的 CPG 工作将大大改善烧伤患者的管理。
