Management of Head and Neck Paragangliomas: AGREE II Appraisal of Clinical Practice Guidelines

Tuesday, October 1, 2024

8:42 AM – 8:48 AM EDT

Location: MBCC, 208

Disclosure(s):

Beatrice C. Go, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Deepak R. Lakshmipathy, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Karthik Rajasekaran, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Clinical practice guidelines (CPGs) have recently been created to help standardize management of head and neck paragangliomas (HNPGLs) given their rarity and anatomic proximity to high-risk structures. Our aim was to critically evaluate available CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and answer whether such guidelines are of sufficient quality.

Methods: Embase, PubMed, Web of Science, and relevant professional society websites were systematically searched for relevant CPGs. Inclusion criteria encompassed all CPGs from database inception through December of 2023 that provided thorough HNPGL management recommendations. Non-English publications and prior versions of existing guidelines were excluded. Four reviewers (DL, EW, CF, OB) trained in AGREE II protocols independently rated each selected CPG over 23 key items and six overarching domains. Ratings served as independent variables with calculated scaled domain scores (SDS) and overall quality designations serving as primary outcomes. Intraclass correlation coefficients (ICCs) were also calculated to assess interrater reliability.

Results: Of 523 initially identified records, 7 CPGs met inclusion criteria. Of these, 3 CPGs were designated as high quality (≥ 60% SDS for ≥ 5 domains) with the remaining 4 being low quality (≥ 60% SDS for ≤ 2 domains). CPGs generally did well in defining their scope and purpose (84.33% ± 14.91%) and clearly presenting recommendations (77.98% ± 18.59%). However, they uniformly struggled in outlining stakeholder involvement (56.15% ± 16.25%), utilizing evidence-based development (50.15% ± 23.64%), offering facile applicability (49.55% ± 17.58%), and delineating independence from outside influence (59.52% ± 39.71%). Interrater reliability was good (0.75 < ICC ≤ 0.9) to excellent (ICC > 0.9) across all domains.

Conclusions: Most current CPGs on management of HNPGLs are of low quality and would significantly benefit from incorporating patient perspectives, protocols and timelines for updating recommendations, health economists, and funding disclosures during future development.

Co-Author(s)

BG

Beatrice C. Go, MD

Resident Physician
University of Pennsylvania Department of Otorhinolaryngology-Head and Neck Surgery
PHILADELPHIA, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Deepak R. Lakshmipathy, BS

Medical Student
Carle Illinois College of Medicine
Fremont, CA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
EW

Eric Winter, MD

University of Pennsylvania, United States

Disclosure information not submitted.
CF

Christian G. Fritz, MD

Fellow
University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
OB

Om Balar

The College of New Jersey, United States

Disclosure information not submitted.
AP

Aman Prasad, MD

Resident
University of Pennsylvania Department of Otorhinolaryngology
Philadelphia, PA, United States

Disclosure information not submitted.
AM

Alvaro Moreira, MD

University of Texas Health Science Center at San Antonio, United States

Disclosure information not submitted.

Senior Author(s)

Karthik Rajasekaran, MD

Associate Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
Department of Otorhinolaryngology Head and Neck Surgery, Hospital of the University of Pennsylvania
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.