Appraisal of clinical practice guidelines for the evaluation and management of neck masses in children

Abstract

Aim The purpose of this systematic review was to use the Appraisal of Guidelines for Research and Evaluation tool to assess the methodological quality of clinical practice guidelines (CPGs) for the workup and management of paediatric neck masses. Methods MEDLINE, Embase, Cochrane and grey literature were searched to identify CPG incorporating paediatric neck masses. Four authors with previous training of the Appraisal of Guidelines for Research and Evaluation tool evaluated the included studies. Results Nine studies met inclusion criteria. The highest scoring domains were ‘Scope and Purpose’ (74.0 ± 4.5) and ‘Clarity of Presentation’ (72.9 ± 6.3). The lowest scoring domains were ‘Rigour and Development’ (18.8 ± 7.5) and ‘Applicability’ (23.7 ± 6.1). One study was ‘High’ quality, three received scores of ‘Average’ and five were found to be ‘Low’ quality. Conclusion The majority of paediatric neck mass CPGs were low to average quality. The domains in need of greatest improvement were ‘Rigour and Development’ and ‘Applicability’, suggesting significant concerns in current CPGs focused on paediatric neck masses.

Surgical management of a midline submental neck mass in Zimbabwe: A case report

“…1 The diagnostic dilemma resulting from the extensive list of potential diagnoses of a pediatric neck mass sparked a review of practice guidelines in recent years. 2 Despite the analysis of pediatric neck masses in a few African countries, 3,4,5 there remains a paucity of guidelines for pediatric neck masses in Zimbabwe. Here, we contribute to the literature on pediatric neck masses in Zimbabwe through a case presentation of a unique midline neck mass.…”

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy

“…One recent prospective study, which was aimed at describing the etiologies of all clinical presentations of cervical adenopathy, demonstrated that among 218 patients, the majority of lymphadenopathy resolved within 8 weeks and that those patients eventually diagnosed with malignancy either had B symptoms or abnormal hilar findings on ultrasound. 10 These data suggest that watchful waiting is a rational approach for asymptomatic cervical lymphadenopathy.…”

“…In the approach to children with persistent but otherwise asymptomatic lymphadenopathy, individual practice patterns vary among specialists, and current literature does not provide evidence-based guidelines for safe and appropriate follow-up. 10 While prior studies have identified certain clinical, laboratory, and radiographic features for suspicious lymphadenopathy, few have addressed the natural history of pediatric patients with asymptomatic cervical lymphadenopathy. One recent prospective study, which was aimed at describing the etiologies of all clinical presentations of cervical adenopathy, demonstrated that among 218 patients, the majority of lymphadenopathy resolved within 8 weeks and that those patients eventually diagnosed with malignancy either had B symptoms or abnormal hilar findings on ultrasound.…”

“…While prior studies have identified certain clinical, laboratory, and radiographic features for suspicious lymphadenopathy, few have addressed the natural history of pediatric patients with asymptomatic cervical lymphadenopathy. One recent prospective study, which was aimed at describing the etiologies of all clinical presentations of cervical adenopathy, demonstrated that among 218 patients, the majority of lymphadenopathy resolved within 8 weeks and that those patients eventually diagnosed with malignancy either had B symptoms or abnormal hilar findings on ultrasound 10 . These data suggest that watchful waiting is a rational approach for asymptomatic cervical lymphadenopathy.…”

“…If the workup does not reveal an etiology, these patients are typically referred to a pediatric surgical specialist for consideration of more invasive sampling to rule out malignancy. In the approach to children with persistent but otherwise asymptomatic lymphadenopathy, individual practice patterns vary among specialists, and current literature does not provide evidence‐based guidelines for safe and appropriate follow‐up 10 …”