THE MANAGEMENT OF MASSIVE BLEEDING IN POLYTRAUMA PATIENTS

- Methodology

This national guideline was developed under the auspices of the Egyptian Health Council (EHC), the Ministry of Health and Population (MOHP), and the World Health Organization (WHO) Egypt Country Office. To ensure international standards of transparency and clinical rigor while maintaining local contextual relevance, the GRADE-ADOLOPMENT methodology was employed for the adaptation of global evidence into the Egyptian clinical landscape [6,7].

A comprehensive search for guidelines was undertaken to identify the most relevant guidelines to consider for adaptation.

Inclusion/ exclusion criteria were followed in the search and retrieval of guidelines to be adapted:

• Selecting only evidence-based guidelines (guidelines must include a report on systematic literature searches and explicit links between individual recommendations and their supporting evidence)

·       Selecting only national and/or international guidelines

·       Selecting peer-reviewed publications only

·       Selecting guidelines written in the English language

·       Excluding guidelines written by a single author, not on behalf of an organization, to be valid and comprehensive, a guideline ideally requires multidisciplinary input

·       Excluding guidelines published without references, as the panel needs to know whether a thorough literature review was conducted and whether current evidence was used in the preparation of the recommendations

The following characteristics of the retrieved guidelines were summarized in:

·       Developing organization/authors

·       Date of publication, posting, and release

·       Country/language of publication

·       Date of posting and/or release

·       Dates of the search used by the source guideline developers

All retrieved Guidelines were screened and appraised using AGREE II instrument (www.agreetrust.org) by at least three members. The panel decided on a cut-off point or ranked the guidelines (any guideline scoring above 50% on the rigor dimension was retained). The GDG decided to adapt the Guidelines for the management of conditions specifically related to stress by the WHO and the Guidelines of the International Society for the Study of Trauma and Dissociation (ISSTD). (2,6)