Practice Management Guidelines for the Prevention of Venous Thromboembolism in Trauma Patients: The EAST Practice Management Guidelines Work Group

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Excerpt

The Eastern Association for the Surgery of Trauma (EAST) has taken a leadership role in the development of evidenced-based practice guidelines for trauma. 1 These original guidelines were developed by interested trauma surgeons in 1997 for the EAST Web site (http://www.east.org), where a brief summary of four guidelines was published. A revised, complete, and significantly edited practice management guidelines for the prevention of venous thromboembolism in trauma patients is presented herein.
The step-by-step process of practice management guideline development, as outlined by the Agency for Health Care Policy and Research (AHCPR), has been used as the methodology for the development of these guidelines. 2 Briefly, the first step in guideline development is a classification of scientific evidence. A Class I study is a prospective, randomized controlled trial. A Class II study is a clinical study with prospectively collected data or large retrospective analyses with reliable data. A Class III study is retrospective data, expert opinion, or a case report. Once the evidence is classified, it can be used to make recommendations. A Level I recommendation is convincingly justifiable on the basis of the scientific information alone. Usually, such a recommendation is made on the basis of a preponderance of Class I data, but some strong Class II data can be used. A Level II recommendation means the recommendation is reasonably justifiable, usually on the basis of a preponderance of Class II data. If there are not enough Class I data to support a Level I recommendation, they may be used to support a Level II recommendation. A Level III recommendation is generally only supported by Class III data.
These practice guidelines address eight different areas of practice management as they relate to the prevention and diagnosis of venous thromboembolism in trauma patients. There are few Level I recommendations because there is a paucity of Class I data in the area of trauma literature. We believe it is important to highlight areas where future investigation may bring about definitive Level I recommendations.

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