Clinical practice guidelines are being used as a means of reducing inappropriate care, controlling geographic variations in practice patterns, and making more effective use of health care resources. Developments at the national health policy level, as well as managed care imperatives, suggest that clinical practice guidelines will play an increasingly prominent role in the practice of medicine. These guidelines can contribute to medicine as an aid in clinical decision making and improving clinical practice [1,2] and as a research tool and an educational resource. We, as trauma surgeons, should participate in such endeavors in an effort to improve trauma care and guide future research. The Agency for Health Care Policy and Research (AHCPR) has led the way in guideline development methodology and currently has published 20 guidelines addressing a variety of topics. [3] Its initial work has led others to develop an evidence-based approach to care. Evidence-based guidelines have been published on intravenous analgesia, sedation, sustained neuromuscular blockade in the intensive care unit, and management of severe head injury. [4-6] Clinical computerized bedside protocols have improved outcome in adult respiratory distress syndrome and hypoxia. [7,8] National literature/consensus-based guidelines have also been published for stress ulcer prophylaxis and albumin transfusion and are currently in development for antibiotic use and fever workup in the intensive care unit. [9,10] The role of the Eastern Association for the Surgery of Trauma (EAST) and other national organizations will be to provide a series of national consensus-based guidelines from which institutionally specific clinical management protocols or pathways can be developed (see Figure 1).Figure 1: Guideline and protocol development.A step-by-step process of practice management guideline development, largely adapted from AHCPR recommendations, has been derived [11] to ensure a combination of rigorous methodology and practical feasibility that can be adapted to clinical decision making at any institution (Table 1). Key to guideline development is assessment of the scientific evidence and formulation of recommendations (Table 2).Table 1: Steps to practice management guideline developmentTable 2: Classification of scientific evidence and formulation of recommendationsA current limitation on the concept of guideline development is the paucity of prospective, randomized class I data for the development of more secure evidence-based guidelines. It is hoped that through the development of guidelines, a baseline can be created to direct future research and create more class I data. With these thoughts in mind, a consensus conference of 20 trauma surgeons interested in guideline development was held and initial topics were selected for development. Each member of the conference selected topics that he or she felt were important for development. Four topics were then selected by majority consensus. Each topic was assigned a chairperson, and the chairperson was then responsible for selecting his or her committee members. The individual committees were given latitude on how to approach their topics, but all were expected to conform to the process described above. Once completed, the guidelines were reviewed by the committee chairperson and the chairperson of the guideline committee and returned for revision. The revised guidelines were submitted to the EAST program chairman, the president of EAST, and the board members. The guidelines were presented at the annual meeting of EAST in 1997, and revisions were made based on comments and suggestions from the members. What follows is an abridged version of these guidelines. The unabridged version, which contains a more lengthy discussion of the scientific evidence, data classification, and evidentiary tables, as well as a complete bibliography, is available through the EAST web page (www.east.org) or by written request. Send requests to: EAST Guidelines, c/o Judith Schultz, Trauma Program Development Office, Lehigh Valley Hospital, Cedar Crest & I-78, P.O. Box 689, Allentown, PA 18105-1556. Practice Management Guidelines for Screening of Blunt Cardiac Injury Michael D. Pasquale, MD, Division of Trauma/Surgical Critical Care, Lehigh Valley Hospital, Allentown, Pa; Kimberly K. Nagy, MD, Department of Trauma, Cook County Hospital, Chicago, Ill; John R. Clarke, MD, Department of Surgery, Allegheny University Hospital, Philadelphia, Pa. Practice Management Guidelines for Identifying Cervical Spine Injuries after Trauma Donald W. Marion, MD, Chairman, Department of Neurosurgery, Presbyterian University Hospital, Pittsburgh, Pa; Robert Domeier, MD, Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, Mich; C. Michael Dunham, MD, St. Elizabeth Hospital Trauma Center, Youngstown, Ohio; Fred A. Luchette, MD, Division of Trauma/Critical Care, University of Cincinnati College of Medicine, Cincinnati, Ohio; Regis Haid, MD, Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Ga; Scott C. Erwood, MD, Emory Clinic, Atlanta, Ga. Practice Management Guidelines for Penetrating Intraperitoneal Colon Injuries C. Gene Cayten, MD, Institute for Trauma and Emergency Care, New York Medical College, Valhalla, NY; Timothy C. Fabian, MD, University of Tennessee College of Medicine, Memphis, Tenn; Victor F. Garcia, MD, Division of Pediatric Surgery, Children's Hospital Medical Center, Cincinnati, Ohio; Rao R. Ivatury, MD, Department of Surgery, New York Medical College/Lincoln Hospital, Bronx, NY; John A. Morris, Jr., MD, Division of Trauma and Surgical Critical Care, Vanderbilt University, Nashville, Tenn. Practice Management Guidelines for Venous Thromboembolism in Trauma Patients - The Use of Low-Dose Heparin (LDH) for Deep Venous Thrombosis/Pulmonary Embolus (DVT/PE) Prophylaxis - The Use of Sequential Compression Devices (SCDs) in the Prevention of DVT/PE - The Role of Low Molecular Weight Heparin in Venous Thromboembolism Prophylaxis in Trauma Patients - The Role of Arteriovenous Foot Pumps in the Prophylaxis of DVT/PE in the Trauma Patient - The Role of the Vena Cava Filter in the Prophylaxis and Treatment of PE - The Role of Treatment of Established DVT/PE with Anticoagulation in the Trauma Patient - The Role of Ultrasonography in Diagnostic Imaging for in Trauma - The Role of in Diagnostic Imaging for in Trauma - The Role of in the of in Trauma Patients MD, Department of Surgery, University of College of Medicine, D. 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