• Lynne Moore, Ben AbdeljelilAnisAPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université La, Pier-Alexandre Tardif, Roger Zemek, Nick Reed, Keith Owen Yeates, Carolyn A Emery, Isabelle J Gagnon, Natalie Yanchar, Mélanie Bérubé, Jennifer Dawson, Simon Berthelot, Antonia Stang, Suzanne Beno, Emilie Beaulieu, Alexis F Turgeon, Melanie Labrosse, François Lauzier, Ian Pike, Alison Macpherson, and Gabrielle C Freire.
• Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada. Electronic address: Lynne.moore@fmed.ulaval.ca.
• Ann Emerg Med. 2024 Apr 1; 83 (4): 327339327-339.

Study ObjectiveOur primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise their overall quality, and synthesize the quality of evidence and the strength of included recommendations.MethodsWe searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.ResultsWe included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses.ConclusionsWe identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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