Mrs. Michelle Thomson1, Professor Zachary Munn1, Associate Professor Paul Simpson2, Dr Robin Pap2, Dr Raju Kanukula1, Dr Grace McBride1
1The University of Adelaide, Adelaide, Australia, 2Western Sydney University, Adelaide, Australia
Biography:
A paramedic and clinical educator with a global EMS career, she serves on the Australasian College of Paramedicine's CPG working group, is the SA nominee for the CAA Women in Ambulance Leadership Program, and is pursuing a master’s in clinical science, focusing on quality improvement and CPG development in Australia.
Abstract:
Background
High-quality, evidence-based clinical practice guidelines (CPGs) support clinicians and optimise patient care, yet many lack rigor and may be misleading. As pain is a common reason for ambulance use, evaluating out-of-hospital pain management CPGs for quality and implementability is essential.
Objective
This review assesses the methodological quality of out-of-hospital pain management CPGs to identify recommendations suitable for paramedic practice.
Methods
Using the PICAR (population, intervention, comparison, attribute, and recommendations) framework and JBI umbrella/scoping review methodology, searches were conducted across 12 databases, including PubMed and Embase, alongside Google searches and direct outreach to out-of-hospital organisations. Identified CPGs were assessed for methodological rigor and clinical credibility using AGREE II and AGREE-REX.
Results
Of 1,103 screened studies, 25 CPGs met inclusion criteria from regions including Australia/Aotearoa New Zealand (11), the USA (3), Canada (4), and single guidelines from South Africa, Iran, Qatar, Ireland, Europe, and the UK. Less than half scored 60% or above on AGREE II, with only nine using a recognised methodological framework. Some high-quality out-of-hospital pain management CPGs were identified.
Conclusion
This study highlights the variability in quality and methodological rigor of pre-hospital pain CPGs, with many lacking clear frameworks. Enhancing guideline development aligns with the Australian NSQHS Standards, particularly Standard 1: Clinical Governance, by ensuring evidence-based, high-quality care. Identifying and improving pain management strategies supports Standard 5: Comprehensive Care, promoting safer, more effective pain management.