Clinical practice guideline for the integrated management of major trauma by the Italian National Institute of Health: process and methods

Overview

This paper describes the process and methods behind the Italian National Institute of Health (ISS) guideline on the integrated management of major trauma. It is not the clinical guideline itself. Recommendations are published separately on Italy's National Guidelines System platform. The Ministry of Health commissioned the guideline because trauma care and outcomes vary widely between regions. Under Italian law, clinical guidelines also play an important role in medical liability.

Scope

The guideline covers people of all ages with major trauma, excluding severe burns, from the scene of injury to definitive care. It addresses both clinical and organisational aspects of pre-hospital and hospital care. Key topics include pre-hospital triage, airway management, chest trauma, haemorrhage, monitoring, pain, heat loss, service organisation, and information and support for patients.

Methods

Rather than starting from scratch, the ISS used the GRADE-ADOLOPMENT approach, which combines adopting, adapting and newly developing recommendations. Two UK NICE guidelines on major trauma, one on assessment and initial management and one on service delivery, were selected as the highest-quality sources. The panel prioritised clinical questions from them and added new questions on topics they did not cover. For each question, systematic reviews were updated or newly conducted, and Evidence-to-Decision frameworks were used to weigh benefits, harms, patient values, acceptability and resources in the Italian context. Recommendations were agreed by consensus or vote and then reviewed by independent external experts.

Participation and transparency

The multidisciplinary panel included trauma surgeons, emergency physicians, anaesthetists, orthopaedic surgeons, a radiologist, a nurse and a lay member. Stakeholders gave input before the scope was drafted, and public online consultations were held on both the scope and the draft recommendations. All participants declared their interests, which were assessed case by case under a formal conflict-of-interest policy.

Implications

The authors conclude that adapting existing high-quality guidelines saves time and resources and should improve local uptake. It still requires advanced methodological skills, and patient and public involvement needs strengthening.