Author: Gamboa JE et al.
Anesthesia & Analgesia 141(3):560–569, September 2025. doi:10.1213/ANE.0000000000007392
This systematic review examined 165 clinical practice guidelines (CPGs) for anesthetic management of trauma published between 2010 and 2023, developed by 122 societies across 51 countries. Most came from high-income countries (HICs), with very limited representation from low- and middle-income countries (LMICs), despite these regions carrying the highest trauma burden. Seventy percent of guidelines were open access, while paid access averaged $36.61. The most common topics were blood and fluid management, shock, and airway/respiratory care.
Guideline quality was moderate (average NEATS score 3.13/5). Strongest areas were clarity of recommendations and disclosure of conflicts, while weakest were patient/public input and plans for updating. Only 28% included a methodologist, but this was the only factor independently associated with high quality (odds ratio 6.81, p<.001). The authors recommend increasing LMIC involvement, improving open access, providing multilingual dissemination, and ensuring methodologist participation to raise global applicability and quality.
What You Should Know
• 165 anesthesia trauma guidelines reviewed; majority authored in high-income countries.
• LMIC authorship was rare (12% first/last authors) despite greatest trauma burden.
• 70% open access, but costs averaged $36.61 for paywalled articles.
• Most frequent topics: hemorrhage, shock, and airway management.
• Quality moderate overall; weakest areas were patient input and guideline updates.
• Having a methodologist strongly predicted higher quality.
• Expanding LMIC participation, translations, and open-access publishing are critical.
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Thank you to Anesthesia & Analgesia for making this work available.