If there is a certainty with care and treatment guidelines, it is that they are out-of-date the minute they are published. This fall, the Ontario Neurotrauma Foundation (ONF) takes a major step to improve the overall timeliness and content of its clinical best practice guidelines by moving to a “living document” format for the release of the upcoming revision of its Guideline for Diagnosing and Managing Pediatric Concussion.
“While a lot of work by everyone involved, moving to the living document process will ensure our guidelines are current, including relevant guidance from published evidence as quickly as possible,” explains Judy Gargaro, ONF Acquired Brain Injury Program Director. “For example, the original Pediatric Guidelines were first published in 2014 and we anticipate online publication of the revision by mid-September 2019. The effort to “catch-up” with the evidence published since 2014 has been enormous.”
The revision process is a thorough and lengthy one. “We started the revision process in January 2018 with a review of concussion-related publications from the previous five years,” says Judy. “With a list of publications in hand, the review of the content of each publication was completed last spring and summer in order to identify the most relevant content for the guideline revision.”
A consensus meeting occurred In October 2018 with leaders in concussion research who were grouped by their areas of expertise. The outcome of this meeting was agreement on changes and additions required to bring the 2014 guidelines as up to date as possible. All the new and revised content was collated and sent back to the consensus participants, and with their input the revised guideline was prepared. External scientific reviewers completed their work at the end of May and the final preparations for release of the revised guideline and updated tools and resources is now underway.
Revised pediatric guideline to be available as the first ONF “living guideline”
At this point, the process to make the revised guidelines a living document takes shape. It will only be published online and will have new information added at least annually based on monthly literature scans, and an annual review and approval process by the expert groups.
“This process ensures new topics are identified and added, and other content is updated regularly,” says Judy. “While it is not possible to have a completely up-to-date document, this will give guideline users certainty that the content informing their clinical decisions is current, peer-reviewed and relevant.”
Revisions and the move to a living document format will be undertaken for the next versions of the Guidelines for Concussion/mTBI and Prolonged Symptoms and the INESSS-ONF Guideline for Rehabilitation of Adults with Moderate to Severe TBI .
“The role of ONF in the development and revision of the guidelines cannot be underestimated. ONF is considered the honest knowledge broker by all stakeholders,” Judy says. “We ensure there is a rigorous scientific and stakeholder consultation process, and this gives guideline users the confidence and assurance they require.”