Guideline on Treatment of Patients with Severe and Multiple ... - AWMF

S3 <strong>Guideline</strong> on Treatment of Patients with Severe and Multiple Injuries
A Rationale und goals
Introduction
Medical guidelines are systematically developed decision aids for service providers and patients
on the appropriate method applicable in specific health problems [1]. <strong>Guideline</strong>s are important
tools for providing a rational and transparent basis for decisions in medical care [2]. Through
imparting knowledge, they are intended to contribute towards improving care [3].
The process of developing guidelines must be systematic, independent and transparent [2].
<strong>Guideline</strong> development for Level 3 guidelines follows the criteria according to the AWMF/ÄZQ
[German Medical Center for Quality in Medicine] specifications including all elements of
systematic development [4].
Table 1: AWMF table of levels for guideline development [4].
Level 1 Experts group:
A representatively formed group of experts from the Scientific Medical Society
draws up a guideline in informal consensus, which is approved by the board of
the society.
Level 2 Formal evidence research or formal consensus finding:
<strong>Guideline</strong>s are developed from formally assessed statements in scientific
literature or discussed and approved in one of the proven formal consensus
processes. Formal consensus processes consist of the nominal group process, the
Delphi method and the consensus conference.
Level 3 <strong>Guideline</strong> including all elements of systematic development:
Formal consensus finding, systematic literature search and evaluation, and
classification of studies and recommendations according to the criteria of
evidence-based medicine, clinical algorithms, outcome analysis, decision
analysis.
The present guideline is a Level 3 guideline.
Starting position
Accidents are the most common cause of death in children and young adults [5]. In 2007, 8.22
million people were injured in accidents and 18,527 people suffered a fatal accident according to
statistics from the German Federal Institute for Occupational Safety and Health (Bundesanstalt
für Arbeitsschutz und Arbeitsmedizin) [6]. The management of a severely injured person is
typically an interdisciplinary task. It presents a major challenge to those involved in the
provision of care because of the sudden occurrence of the accident situation, the unpredictability
of the number of injured persons and the heterogeneity of the patient population [7].
An S1 guideline was issued by the German Society of Trauma Surgery in 2002 on the
management of multiply injured patients and those with severe injuries. However, there is no upto-date,
general, comprehensive, evidence-based guideline. This was the rationale for drawing up
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