Tonsillar-related pathologies: An analysis of the evidence underpinning management recommendations

Trevor Torgerson; Brayden Rucker; Ross Nowlin; Steven Curry; Craig Cooper; Matt Vassar

doi:10.1016/j.ijporl.2021.110992

Tonsillar-related pathologies: An analysis of the evidence underpinning management recommendations

Int J Pediatr Otorhinolaryngol. 2022 Jan:152:110992. doi: 10.1016/j.ijporl.2021.110992. Epub 2021 Dec 3.

Authors

Trevor Torgerson¹, Brayden Rucker², Ross Nowlin², Steven Curry³, Craig Cooper², Matt Vassar²

Affiliations

¹ Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA. Electronic address: Trevor.torgerson@okstate.edu.
² Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
³ Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA.

PMID: 34883327
DOI: 10.1016/j.ijporl.2021.110992

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.

MeSH terms

Humans
Palatine Tonsil*
Practice Guidelines as Topic
Research Design*