Systematic review of guidelines for care of intersex people in the emergency department.

Purpose: Intersex people make up 1.7-4% of the population of North America. A recent scoping review of emergency department (ED) relevant literature for the care of sexual and gender minorities found almost no representation of this population. Intersex people have unique equity, diversity, and inclusion needs in the ED, so we undertook a review of international guidelines to identify ED-relevant recommendations.

Methods: Using the PRISMA criteria, we systematically searched OVID Medline, EMBASE, CINAHL, and the gray literature for any clinical practice guideline (CPG) or best practice statement (BPS) published until Oct 21, 2022. We included articles in English, which included care of intersex people of any age, in any setting, region, or nation, and were of national or international in scope. We excluded primary research, systematic or narrative reviews, non-CPS or BPS statements, editorials, articles of regional or individual hospital scope, or if a more recent version had been published. Recommendations relevant to the ED were identified and the guideline and recommendations scored for quality using the AGREE-II and AGREE-REX tools respectively.

Results: Of 1599 studies identified, 1400 studies were excluded, 199 full-text reviews completed, and 95 studies included for evaluation. There were no ED-relevant recommendations found among these guideline documents.

Conclusion: A systematic review of the literature for ED-relevant guidelines for the care of Intersex populations returned no results. Given the risk of increasing barriers to care for intersex people, and the increasing use of the ED for primary care, the requirements of Intersex people need to be investigated and integrated into future development of a CPG for care of sexual and gender minority populations in the ED.