Clinical Practice Guideline Recommendations in Pediatric Orthopaedic Injury: A Systematic Review

Lynne Moore, Justin Drager, Gabrielle Freire, Natalie Yanchar, Anna N. Miller, Anis Ben Abdel, Mélanie Bérubé, Pier Alexandre Tardif, Janyce Gnanvi, Henry T. Stelfox, Marianne Beaudin, Antonia Stang, Suzanne Beno, Matthew Weiss, Melanie Labrosse, Roger Zemek, Isabelle J. Gagnon, Emilie Beaulieu, Simon Berthelot, Terry KlassenAlexis F. Turgeon, François Lauzier, Belinda Gabbe, Sasha Carsen

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Background: Lack of adherence to recommendations on pediatric orthopaedic injury care may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aimed to identify CPGs for pediatric orthopaedic injury care, appraise their quality, and synthesize the quality of evidence and the strength of associated recommendations. Methods: We searched Medline, Embase, Cochrane CENTRAL, Web of Science and websites of clinical organizations. CPGs including at least one recommendation targeting pediatric orthopaedic injury populations on any diagnostic or therapeutic intervention developed in the last 15 years were eligible. Pairs of reviewers independently extracted data and evaluated CPG quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. We synthesized recommendations from high-quality CPGs using a recommendations matrix based on the GRADE Evidence-to-Decision framework. Results: We included 13 eligible CPGs, of which 7 were rated high quality. Lack of stakeholder involvement and applicability (i.e., implementation strategies) were identified as weaknesses. We extracted 53 recommendations of which 19 were based on moderate or high-quality evidence. Conclusions: We provide a synthesis of recommendations from high-quality CPGs that can be used by clinicians to guide treatment decisions. Future CPGs should aim to use a partnership approach with all key stakeholders and provide strategies to facilitate implementation. This study also highlights the need for more rigorous research on pediatric orthopaedic trauma.

Original languageEnglish
Pages (from-to)E790-E797
JournalJournal of Pediatric Orthopaedics
Issue number10
StatePublished - Nov 1 2023


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