BJS Open. 2022 Jan 6;6(1). doi: 10.1093/bjsopen/zrac005.
Existing emergency general surgery (EGS) guidelines rarely include evidence from low- and middle-income countries (LMICs) and may lack relevance to low-resource settings. The aim of this study was to develop global guidelines for EGS that are applicable across all hospitals and health systems.
A systematic review and thematic analysis were performed to identify recommendations relating to undifferentiated EGS. Those deemed relevant across all resource settings by an international guideline development panel were included in a four-round Delphi prioritization process and are reported according to International Standards for Clinical Practice Guidelines. The final recommendations were included as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack relevant resources at present but should plan for future implementation).
After thematic analysis of 38 guidelines with 1396 unique recommendations, 68 recommendations were included in round 1 voting (410 respondents (219 from LMICs)). The final guidelines included eight essential, one desirable, and three critically unwell patient-specific recommendations. Preoperative recommendations included guidance on timely transfers, CT scan pathways, handovers, and discussion with senior surgeons. Perioperative recommendations included surgical safety checklists and recovery room monitoring. Postoperative recommendations included early-warning scores, discharge plans, and morbidity meetings. Recommendations for critically unwell patients included prioritization for theatre, senior team supervision, and high-level postoperative care.
This pragmatic and representative process created evidence-based global guidelines for EGS that are suitable for resource limited environments around the world.
现有的急诊普通外科（EGS）指南很少包含来自中低收入国家（LMICs）的证据，并且可能与资源匮乏的环境缺乏相关性。本研究旨在制定适用于所有医院和卫生系统的全球 EGS 指南。
进行了系统评价和主题分析，以确定与未分化 EGS 相关的建议。由国际指南制定小组认为适用于所有资源环境的建议被纳入四轮 Delphi 优先排序过程，并根据国际临床实践指南标准进行报告。最终建议被列为必要的（应优先实施的基线措施）或理想的（一些医院目前可能缺乏相关资源，但应计划未来实施）。
对 38 项指南中的 1396 项独特建议进行主题分析后，有 68 项建议纳入了第一轮投票（410 名受访者（219 名来自 LMICs））。最终指南包括八项必要建议、一项理想建议和三项重症患者特定建议。术前建议包括及时转移、CT 扫描路径、交接和与高级外科医生讨论的指导。围手术期建议包括手术安全检查表和恢复室监测。术后建议包括预警评分、出院计划和发病率会议。重症患者的建议包括手术室优先、高级团队监督和高级术后护理。
这一务实且具有代表性的过程为全球 EGS 制定了基于证据的指南，适用于世界各地资源有限的环境。
