What is Pediatric pathways in Primary Care?

Pediatric Pathways in Primary Care is a publication of the Primary Care Spanish Pediatric Association (AEPap)

It is a free access, continuously updated Web publication consisting of a compendium of clinical pathways or decision trees referring to the main reasons for consultation in primary care pediatrics, sorted by specialties. There is a prevision of a total of around 100 algorithms, which will be incorporated gradually.

Efforts have been made to ensure that all contents are based on the best and most updated scientific evidence, through a systematic and critical review, but their application should never replace the clinical judgment of the physician and the individual assessment of each patient.

These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstance, the needs of each patient and their family, and/or the availability of various resources at the health care system where the patient is located.

Pediatric Pathways in Primary Care does not warrant that the clinical pathways are in every aspect accurate or complete, or that one or more of them apply to a particular patient or medical condition.

Instructions for use

Each pathway tries to follow the usual sequence of a medical interview: starting from a symptom or sign and through the anamnesis and physical examination, raise the diagnostic possibilities and establish the appropriate management and follow-up for each of them. Each proposed decision contains the bibliographical reference that supports it.

Some text boxes have letters in different colors inside them. If you click the letter a pop-up windows will open. In this new window you can see extended information about the issue or the justification of the recommendation founded into the box. At the same time, the bibliographical references of the text of the displayed windows are opened by clicking on the corresponding number, being possible to directly access the article if it is available on the internet. Important efforts have been made to outline the level of evidence and grade of recommendation.

Levels of evidence according to Scottish Intercollegiate Guidelines Network (SIGN)

1++ High-quality meta-analyses, high-quality systematic reviews of clinical trials with very little risk of bias.
1+ Well-conducted meta-analyses, systematic review of clinical trials or well-conducted clinical trials with low risk of bias.
1- Meta-analyses, systematic reviews of clinical trials or clinical trials with high risk of bias.
2++ High-quality systematic reviews of cohort or case and control studies; cohort or case and control studies with very low risk of bias and high probability of establishing a causal relationship.
2+ Well-conducted cohort or case and control studies with low risk of bias and moderate probability of establishing a causal relationship.
2- Cohort or case and control studies with high risk of bias and significant risk that the relationship is not causal.
3 Non-analytical studies, such as case reports and case series.
4 Expert opinion.

Grades of Recommendations: SIGN

A At least one meta-analysis, systematic review or clinical trial classified as 1++ and directly applicable to the target population of the guideline, or a volume of scientific evidence comprising studies classified as 1+ and which are highly consistent with each other.
B A body of scientific evidence comprising studies classified as 2++, directly applicable to the target population of the guideline and highly consistent with each other, or scientific evidence extrapolated from studies classified as 1++ or 1+.
C A body of scientific evidence comprising studies classified as 2+, directly applicable to the target population of the guideline and highly consistent with each other, or scientific evidence extrapolated from studies classified as 2++.
D Level 3 or 4 scientific evidence, or scientific evidence extrapolated from studies classified as 2+.

About us

The Pediatric Pathways in Primary Care are sponsored by the AEPap and have the collaboration of its working groups. The editorial team of the guide is composed by a group of primary care pediatricians:

  • Miguel Ángel Fernández-Cuesta Valcarce (Coordinador) (Madrid)
  • María Aparicio Rodrigo (Madrid)
  • Teresa Arana Navarro (Zaragoza)
  • Ángel José Carbajo Ferreira (Madrid)
  • Carmen García Rebollar (Madrid)
  • Pedro Martín Muñoz (Sevilla)
  • Eduardo Ortega Páez (Granada)
  • Juan Ruiz-Canela Cáceres (Sevilla).

Numerous primary care pediatricians cooperate as authors, whose unselfish contribution we would like to thank.

Declaration of conflicting interests

The editors of the Pediatric Pathways in Primary Care declare no conflicts of interest regarding the preparation and publication of the contents of this guide.

Disclaimer

The information of the Pediatric Pathways in Primary Care is not intended to replace the clinical judgement of the user. Any decision or action, taking into account the advice given in this guide, will be the sole and exclusive responsibility of those who apply it, exempting from any responsibility to AEPap, promoters, authors and editors of the Guide.

Accessing this Guide, users accept these terms and conditions.

Sponsoring and advertising.

The website Pediatric Pathways in Primary Care is not sponsored by any commercial company nor hosts advertising for its maintenance on the internet.

Intellectual property rights

According to the Intellectual Property Law, the contents of this resource can be downloaded and reprinted for private use, provided that the copy is made for purposes of study, teaching research and noncommercial use. Any other use of these materials must have the express authorization of AEPap. In all cases, the source from which the documents have been obtained must be indicated.

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