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American Association for the Surgery of Trauma emergency general surgery guidelines gap analysis

Schuster, Kevin, MD; Davis, Kimberly, MD; Hernandez, Matthew, MD; Holena, Daniel, MD; Salim, Ali, MD; Crandall, Marie, MD

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 909–915
doi: 10.1097/TA.0000000000002226

BACKGROUND Emergency general surgery (EGS) has been rapidly adopted as one of the major components of acute care surgery. Although heterogenous, the most common disease states that comprise EGS often have published guidelines containing recommendations for their diagnosis and management. Not all diseases included within EGS however have published guidelines and existing guidelines may have important gaps in their recommendations. We present a thorough assessment of the existing guidelines for the most common EGS diseases and highlight gaps that will require additional literature review or new research to fill.

METHODS Literature searches for existing comprehensive guidelines were performed. These guidelines were summarized based on level of supporting evidence and further subcategorized based on American Association for the Surgery of Trauma (AAST) grade of disease. Using these summaries, gaps in the exiting recommendations were then generated and refined through review by at least two authors.

RESULTS The initial gap analysis focused on diverticulitis, acute pancreatitis, small bowel obstruction and acute cholecystitis. Despite extensive research into each of these disease processes, critical questions regarding diagnosis and management remain to be answered. Gaps were the result of either low quality research or a complete lack of research. The use of the AAST grade of disease established a framework for evaluating these guidelines and grouping the recommendations.

CONCLUSIONS Despite extensive prior research, EGS diseases have multiple areas where additional research would likely result in improved patient care. Consensus on the most important areas for additional research can be obtained through analysis of gaps in existing guidelines. This gap analysis has the potential to inform efforts around developing a research agenda for EGS.

From the Department of Surgery (K.S.), Department of Surgery (K.D.), Yale School of Medicine, New Haven, Connecticut; Department of Surgery (M.H.), Mayo Medical Center, Rochester, Minnesota; Department of Surgery (D.H.), University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery (M.C.), Brigham and Women's Hospital, Boston, Massachusetts.

Submitted: September 17, 2018, Revised: December 3, 2018, Accepted: December 29, 2018, Published online: Month DD, YYYY.

Address for reprints: Marie Crandall, MD, University of Florida College of Medicine Jacksonville, 655 W. 8th St, Jacksonville, FL 32209; e-mail:

© 2019 Lippincott Williams & Wilkins, Inc.