A Systematic Review of Guidelines for Emergency Department Care of Sexual Minorities: Implementable Actions to Improve Care

TL;DR

This paper reviews guidelines for emergency department care of sexual minorities and identifies 11 actionable recommendations to improve their health outcomes.

Contribution

The study provides the most comprehensive review of guidance for emergency care of sexual minorities and highlights opportunities for community-led guideline development.

Findings

Only nine articles provided 11 ED-relevant recommendations for sexual minority care.

Six of the 11 recommendations were identified as high quality and adaptable.

Recommendations include screening, testing, and care for HIV+ sexual minorities and trauma care for men who have sex with men.

Abstract

Sexual minorities, including lesbian, gay, bisexual, asexual, pansexual, and others make up 4.0–5.4% of the North American population. Stigmatization and minority stress can lead to poorer health status in sexual minorities, and a previous scoping review showed gaps in the emergency medicine (EM) literature for care of sexual minorities. In this review we sought to examine existing guidelines for the care of sexual minorities that made recommendations relevant to care in the emergency department (ED).

Using the PRISMA criteria, we performed a systematic search of OVID Medline, EMBASE, CINAHL, and the grey literature for clinical practice guidelines (CPG) and best practice statements (BPS) published until July 31, 2022. Articles were included if they were in English, included medical care of sexual minority populations of any age, in any setting, region, or nation, and were of national or international scope. Exclusion criteria included primary research studies, systematic or narrative reviews or otherwise non-CPG or BPS statements, editorials or letters to the editor, articles of regional or individual hospital scope, non-medical articles, or if a more recent version of the CPG or BPS existed. We identified, recorded, and assessed for quality all recommendations relevant to using the AGREE-II and AGREE-REX tools. Inter-rater reliability was assessed using the interclass correlation coefficient. We coded recommendations for the relevant point of care while in the ED (triage, registration, rooming, investigations, etc).

We excluded 2,413 of 2,534 unique articles. Only nine articles contributed 11 ED-relevant recommendations. Seven of the nine articles were found to be of moderate to high quality; 6 of 11 recommendations were identified as high quality and adaptable. They included recommendations for screening, testing, and care of HIV+ sexual minority populations, and general or trauma care for men who have sex with men and sexual minority populations in general.

This is the most comprehensive review of guidance documents for care of sexual minority populations to date. It identifies 11 actionable recommendations for the ED and identifies opportunities for community-led development of comprehensive clinical practice guidelines for care of sexual minority populations in the ED.

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