Adherence to American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines: A Systematic Review

Abstract

Objective Clinical practice guidelines synthesize and disseminate the best available evidence to guide clinical decisions and increase high-quality care. Since 2004, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) has published 16 guidelines. The objective of this review was to evaluate clinicians’ adherence to these guidelines’ recommendations as measured in the literature. Data Sources We searched PubMed, Embase, and Web of Science on August 29, 2019, for studies published after June 1, 2004. Review Methods We systematically identified peer-reviewed studies in English that reported clinician adherence to AAO-HNSF guideline recommendations. Two authors independently reviewed and abstracted study characteristics, including publication date, population, sample size, guideline adherence, and risk of bias. Results The search yielded 385 studies. We excluded 331 studies during title/abstract screening and 32 more after full-text review. The remaining 22 studies evaluated recommendations from 8 of the 16 guidelines. The Otitis Media with Effusion, Polysomnography, Tonsillectomy, and Sinusitis guidelines were studied most. Study designs included retrospective chart reviews (7, 32%), clinician surveys (7, 32%), and health care database analyses (8, 36%). Studies reported adherence ranging from 0% to 99.8% with a mean of 56%. Adherence varied depending on the recommendation evaluated, type of recommendation, clinician type, and clinical setting. Adherence to the polysomnography recommendations was low (8%-65.3%). Adherence was higher for the otitis media with effusion (76%-90%) and tonsillectomy (43%-98.9%) recommendations. Conclusions Adherence to recommendations in the AAO-HNSF guidelines varies widely. These findings highlight areas for further guideline dissemination, research about guideline adoption, and quality improvement.

Analysis of Systematic Reviews in Clinical Practice Guidelines for Head and Neck Cancer

“…12,13 Although there are identified advantages to CPGs, evidence suggests a lack of adherence to CPGs in otolaryngology. [14][15][16][17][18] Additionally, CPGs display a range of differences in their development process, methodological quality, and content. [19][20][21] This variability can act as a nidus for bias.…”

“…CPGs aim to improve the quality of care by dissemination of the best available evidence into recommendations to provide the most appropriate clinical care and have many advantages—such as aiding decision‐making by relevant up‐to‐date evidence, improving health care consistency, promoting health service equity, and reducing inadequate variability in clinical practice 12,13 . Although there are identified advantages to CPGs, evidence suggests a lack of adherence to CPGs in otolaryngology 14–18 . Additionally, CPGs display a range of differences in their development process, methodological quality, and content 19–21 .…”

Diagnosis of Guillain-Barré syndrome and use of Brighton criteria in Peruvian hospitals

“…In the present study, the rate of application of the BC for GBS diagnosis with level 1 diagnostic certainty was lower (13.4%) than in studies conducted in the Netherlands, India and Bangladesh, which met the criteria for level 1 in 61%, 62% and 58% of the patients, respectively [7][8][9] . This finding might be explained by lack of knowledge of these criteria and the recommendations for its use, or by physicians' disagreement with their use 15,16 . In addition, the lower proportion of Peruvian neurologists, in contrast with the World Health Organization recommendations, may have contributed to lower use of the BC 17 .…”

Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to “Brain Fog”

“… 38 The authors stated that not all children with adenotonsillar hypertrophy suffer also from sleep breathing disorders and that the correlation between the degree of lymphatic structures hypertrophy and the severity of obstructive respiratory symptoms is not linear. However, the same authors discuss the efficacy of adenotonsillectomy for pediatric OSAS and, according to the guidelines for tonsillectomy (American Academy of Otolaryngology-Head & Neck Surgery), 39 suggest to consider the surgical therapeutic option also for PANDAS/PANS patients.…”