@article{e925eeb8aabe48c2984a392f0b1eda23,
title = "Tonsillar-related pathologies: An analysis of the evidence underpinning management recommendations",
abstract = "Objective: Evidence-based decision making is crucial in reducing the health and economic burdens imposed by tonsillar-related pathologies. Clinical practice guidelines are used to guide these decisions; however, uptake of recommendations in these guidelines is low. Systematic reviews are the highest level of evidence used to influence guideline recommendations; therefore, improving the reporting and methodological quality of systematic reviews related to tonsillar-related pathologies may improve guideline uptake and patient care. Methods: We used PubMed to search for all clinical practice guidelines related to tonsillar-related pathologies from 2010 to 2020. Included guidelines were then searched for all systematic reviews and meta-analyses. Study characteristics were extracted from each cited systematic review/meta-analysis before being evaluated using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) instruments. We then compared systematic reviews conducted by a Cochrane systematic review group with non-Cochrane systematic reviews. Results: Seven clinical practice guidelines were included in our study and within these guidelines 98 SRs/MAs were cited, 80 of which were unique and included. Systematic reviews composed 9.1% (98/1082) of all guideline citations. Guideline PRISMA scores ranged from 0.47 to 0.83 with a mean score of 0.71 (n = 80) and guideline AMSTAR-2 scores ranged from 0.52 to 0.83 with a mean of 0.56 (7.29/13) and 0.75 (11.94/16) (n = 80). Cochrane systematic reviews displayed greater PRISMA (0.88 vs. 0.64: p < 0.001) and AMSTAR-2 (0.90 vs. 0.57; p < 0.001) scores compared to the non-Cochrane studies. We found PRISMA and AMSTAR-2 scores were positively correlated across guidelines (r = 0.93). Conclusion: Wide variation exists in adherence to PRISMA and AMSTAR-2 guidelines among systematic reviews cited in clinical practice guidelines for tonsillar-related pathologies. Prior registration and adequate risk of bias assessment are two areas where improvements may be needed. Given the importance of guideline uptake, careful considerations to improve the methodological and reporting quality of evidence supporting tonsillar-related pathology recommendations are necessary.",
keywords = "Clinical practice guidelines, Evidence-based medicine, PRISMA, Systematic reviews, Tonsillectomy",
author = "Trevor Torgerson and Brayden Rucker and Ross Nowlin and Steven Curry and Craig Cooper and Matt Vassar",
note = "Funding Information: Dr. Vassar reports receipt of funding from the National Institute on Drug Abuse , the National Institute on Alcohol Abuse and Alcoholism , the US Office of Research Integrity , Oklahoma Center for Advancement of Science and Technology , and internal grants from Oklahoma State University Center for Health Sciences — all outside of the present work. Funding Information: Clinician adherence to otolaryngology clinical practice guidelines is variable, and studies have shown limited changes in practices after the publication of these guidelines [4,41] [ ?] [ 43]. While adherence to some recommendations such as the appropriate use of pre-adenotonsillectomy polysomnography is dependent on external factors (i.e. necessary resources), other recommendations such as avoiding the prescription of antibiotics after tonsillectomy do not [4,41,42]. Prior research on barriers to adopting recommendations in guidelines have identified a number of areas for intervention. Among these is the need for guidelines to provide clear intervention goals supported by a robust appraisal of the evidence, considerations of guideline applicability, and exceptions to the guidelines themselves to avoid ?cookbook? rigidity [5,6,44] The updated guidelines on tonsillectomy in children developed by the American Academy of Otolaryngology-Head and Neck SurgeryFoundation have expanded and improved their analysis of the literature and their recommendations to further account for patient preferences, the strength of evidence, differences of opinion, and exclusions to the action statements [45]. Clear reporting of the strengths and weaknesses of the systematic reviews cited in a guideline, and the studies contained within these systematic reviews, supports these goals of delivering clarity to guideline recommendations. As one author stated: ?Clear, clinically relevant CPGs with rigorous methodology are the foundation for their effective uptake? [46].Dr. Vassar reports receipt of funding from the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the US Office of Research Integrity, Oklahoma Center for Advancement of Science and Technology, and internal grants from Oklahoma State University Center for Health Sciences ? all outside of the present work. Publisher Copyright: {\textcopyright} 2021",
year = "2022",
month = jan,
doi = "10.1016/j.ijporl.2021.110992",
language = "English",
volume = "152",
journal = "International Journal of Pediatric Otorhinolaryngology",
issn = "0165-5876",
publisher = "Elsevier Ireland Ltd",
}