xRead - September 2022

Wise et al.

Page 4

Some of the topics, such as those providing background or definitions, were assigned as literature reviews without evidence grades. Certain topics that were not appropriate for clinical recommendations were assigned as evidence-based reviews without recommendations (EBRs). Topics that had evidence to inform clinical recommendations were assigned as EBRRs. Each topic author received specific instructions to perform a systematic review for the topic literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standardized guidelines. 4 Ovid MEDLINE ® (1947-September 2016), EMBASE (1974-September 2016), and Cochrane Review databases were included. The search began by identifying any previously published systematic reviews or guidelines pertaining to the assigned topic. Since clinical recommendations are best supported by high-quality evidence, the search focused on identifying RCTs and meta-analyses of RCTs to provide the highest level of evidence (LOE). Reference lists of all identified studies were examined to ensure all relevant studies were captured. If the authors felt as though a non-English study should be included in the review, it was instructed that the paper be appropriately translated to minimize the risk of missing important data during the development of recommendations. 4 To optimize transparency of the evidence, all included studies in EBR and EBRR topic sections are presented in a standardized table format and the quality of each study was evaluated to receive a level based on the Oxford LOE (level 1a to 5). 5 At the completion of the systematic review and research quality evaluation for each clinical topic, an aggregate grade of evidence was produced for the topic based on the guidelines from the American Academy of Pediatrics Steering Committee on Quality Improvement and Management (AAP SCQIM) 6 (Table II.A-1). After providing an aggregate grade of evidence for each EBRR topic (A to D), a recommendation using the AAP SCQIM guidelines was produced (Table II.A-2). It is important to note that each evidence-based recommendation took into account the aggregate grade of evidence along with the balance of benefit, harm, and costs. A summary of the EBRR development process is provided in Figure II.A-1. Following the development of the initial topic text and any associated evidence tables, evidence grades, and recommendations, each section underwent a 2-stage online iterative review process using 2 independent reviewers (Fig. II.A-2). The purpose of the topic iterative review process was to evaluate the completeness of the identified literature and ensure that any EBRR recommendations were appropriate. The content of the first draft from each topic section was reviewed by a first reviewer, and all changes were agreed upon by the initial author and this first reviewer. The revised topic section was then subsequently reviewed by a second reviewer. Initial authors of the topic and both assigned reviewers agreed upon all changes before each section was considered appropriate to proceed into the final ICAR statement stage.

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II.B. Iterative review

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.