Generating new evidence is only one part of improving patient care. Clinicians must also be able to understand the evidence that already exists, determine its quality, reconcile conflicting findings, and translate the best available evidence into clinical practice.
The Evidence Synthesis & Clinical Guidelines program, led by Dr. Rondi Gelbard, brings together expertise in systematic review, meta-analysis, evidence appraisal, consensus methodology, and guideline development to address important questions in trauma, emergency general surgery, and surgical critical care.
The program works with investigators at UAB and collaborators nationally and internationally to transform complex and sometimes inconsistent bodies of literature into evidence that can guide clinical practice and identify priorities for future research.
Systematic Reviews and Meta-Analyses
Systematic reviews and meta-analyses provide a rigorous framework for identifying, evaluating, and synthesizing existing research.
Our work begins with focused clinical questions and uses reproducible methods to identify relevant studies, assess their quality and risk of bias, and determine whether results can appropriately be combined.
This approach is particularly important in trauma, acute care surgery, and critical care, where many clinical questions cannot readily be addressed by large randomized trials and the available evidence may consist of smaller trials, observational studies, or heterogeneous clinical populations.
Evidence synthesis can therefore answer important clinical questions—but it can also reveal where the evidence remains insufficient and where new prospective studies or clinical trials are needed.
From Evidence to Clinical Guidelines
A major focus of the program is translating evidence synthesis into practical recommendations for clinicians.
Dr. Gelbard has led and contributed to multiple evidence-based practice management guidelines through the Eastern Association for the Surgery of Trauma (EAST) and other national professional organizations.
Examples include work addressing:
- Timing of surgical debridement for necrotizing soft-tissue infection
- Management of ileus in surgical patients
- Treatment of acute noninfectious diarrhea in critically ill patients
- Emergency management of incarcerated and strangulated inguinal hernias
- Antibiotic prophylaxis in injured and critically ill surgical patients
- Nutrition in older surgical patients
- Neurostimulant therapy following traumatic brain injury
These projects use systematic review and formal evidence-grading methods to move from a clinical question to a transparent assessment of the available evidence and, where the evidence permits, actionable recommendations for clinical practice.
Importantly, evidence-based guideline development also requires acknowledging uncertainty. When the available literature cannot support a recommendation, identifying that uncertainty is itself valuable: it defines the questions that should be addressed by future research.
Defining What Future Studies Should Measure
Evidence synthesis frequently identifies another problem: different studies investigating the same condition may measure entirely different outcomes.
This makes studies difficult to compare and can make meaningful meta-analysis impossible.
The Evidence Synthesis program has therefore developed particular expertise in core outcome set development using structured consensus methods such as the modified Delphi process.
Dr. Gelbard led an international EAST initiative to establish a core outcome set for massive transfusion research. The project brought together experts from trauma surgery, transfusion medicine, emergency care, and clinical research to identify a standardized set of outcomes that should be considered in future studies of massive transfusion.
She has also contributed to the development of core outcome sets for conditions including acute appendicitis and acute necrotizing pancreatitis.
Core outcome sets do not dictate how a study must be designed. Instead, they establish a common language for future research so that studies addressing similar questions can be compared, combined, and interpreted more effectively.
Consensus Methods
Not every important clinical question has sufficient evidence to support a conventional systematic review or meta-analysis.
When evidence is limited, heterogeneous, or evolving, structured consensus methods can provide a rigorous way of defining areas of agreement and uncertainty.
The program uses methods including Delphi and modified Delphi processes, expert panels, consensus conferences, and structured surveys to bring together multidisciplinary groups of clinicians, researchers, and other stakeholders.
These approaches can be used to develop core outcome sets, establish research priorities, define areas of clinical consensus, and identify questions where disagreement or uncertainty demonstrates the need for further investigation.
Through her work with the American Association for the Surgery of Trauma (AAST), Dr. Gelbard has helped develop national clinical consensus documents on topics including Post-intensive Care Syndrome (PICS), Geriatric Nutrition and procedural antibiotic prophylaxis.
Evidence Synthesis as a Research Tool
Evidence synthesis is not simply a way of summarizing research that has already been completed. It is also an important tool for designing better future research.
A rigorous review conducted before a new study can determine:
- What is already known
- Where important uncertainty remains
- Which populations have been inadequately studied
- Which outcomes have previously been measured
- Whether existing studies can meaningfully be compared
- Which effect sizes might reasonably be expected
- Whether another study is necessary
- Which questions should be prioritized for future clinical trials
In this way, evidence synthesis connects directly with the Center for Injury Science's clinical trials, observational research, and translational science programs.
From Evidence to Practice
The final step is ensuring that evidence actually reaches patients.
Dr. Gelbard's work spans the continuum from systematic evidence review to national practice guidelines and local clinical protocols. This includes translating national recommendations and emerging evidence into practical guidance for the care of injured and critically ill patients at UAB.
For example, her work in surgical infection and critical care includes evidence-based guidance addressing antimicrobial use, infection prevention, and the diagnosis and treatment of ventilator-associated pneumonia.
This reflects a central philosophy of the program: evidence synthesis is most valuable when it changes what clinicians do.
Collaboration
Evidence synthesis is inherently collaborative.
Projects frequently involve trauma and acute care surgeons, intensivists, emergency physicians, methodologists, epidemiologists, statisticians, librarians and information specialists, and content experts from other disciplines.
The Evidence Synthesis & Clinical Guidelines program collaborates with investigators within UAB and with professional organizations and research groups nationally and internationally.
We can assist investigators and organizations with:
- Systematic reviews
- Meta-analyses
- Scoping and evidence reviews
- Development of clinical practice guidelines
- Evidence grading utilizing GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and PICO (Population, Intervention, Comparator, Outcome) framework
- Delphi and modified Delphi studies
- Core outcome set development
- Consensus methodology
- Research-priority setting
- Translation of evidence into clinical protocols
Gelbard, Rondi B., M.D.
Associate Scientist, Center for Injury Science
Associate Professor and Trauma/Burn ICU Medical Director, Division of Acute Care Surgery UAB Department of Surgery