xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

TABLE III.2 Aggregate grade of evidence (AGE) and recommendation development guidelines. 9

Preponderance of benefit over harm

Balance of benefit andharm

Preponderance of harm over benefit

Evidence quality (AGE) A. Well-designed randomized controlled trials (RCTs)

Strong

Option

Strong

Recommendation

Recommendation Against

B. RCTs with minor limitations; Overwhelmingly consistent evidence from observational studies C. Observational studies (case control and cohort design) D. Expert opinion, case reports, Reasoning from first principles

Recommendation

Recommendation Against

Option

No Recommendation

D Limitations There are noted limitations to any large-scale, multiau thor, multidisciplinary document spanning the breadth and depth of a topic such as sinonasal tumors. First, there is wide variability in the quality of literature across top ics, and authors in different disciplines may have different frameworks of what literature states about a particular topic. Yet, with a large number of contributing authors and editorial members, it is not possible or practical to assess inherent bias in interpreting the literature or reviewing the sections. Second, case reports, case series, and studies with low sample size ( n < 5–10) were purposely excluded, and thus it is challenging to provide a truly comprehensive assessment of studies. Third, despite efforts to be consis tent with assigning LOE per the Oxford 2011 guidelines, the process remains somewhat subjective, and different articles may be interpreted with varying LOE by differ ent readers. Fourth, the editorial team encouraged each author team to freely interpret the literature and complete the evidence tables as they determined fit, and thus there may be some variability in table formatting across sections. Finally, with a rapidly growing field such as sinonasal tumors, where new discoveries can completely change tumor classification schemes (i.e., the recent update of the WHO Classification of Tumors to its 5th edition in 2022 17 ), the editorial team recognizes that not all relevant topics may be included in the current document. SECTION I: GENERAL PRINCIPLES IV INCIDENCE AND EPIDEMIOLOGY Benign and malignant sinonasal tumors are a clinically and pathologically heterogeneous group of neoplasms. 17,19 As described in the WHO classification system, it is help ful to divide sinonasal tumors into categories based on the

TABLE III.3 Reporting guidelines for aggregate grade of evidence (AGE) with evidence-based recommendations. Items Explanation Aggregate

*The final aggregate grade of evidence. *In parentheses, it is helpful to state the total number of individual studies for each research quality level of evidence. **For example, the “Aggregate Grade of Evidence” section would state: B (Level 1: three studies; Level 2: two studies) Explicitly state the benefits offered by the clinical intervention Explicitly state the potential harm of using the clinical intervention May include the following: 1. Direct costs: monetized value for any relevant interventions 2. Indirect costs: time off work, time for daily therapy. The authors’ decision for the balance of benefit to harm A statement that the authors feel is important for the readers to understand while evaluating the clinical topic *Clearly defined recommendation level: using the AAP recommendation strategy *Categorized as: Strong Recommendation , Recommendation , Option , Recommendation Against , Strong Recommendation Against , No Recommendation A clinical practice, supported by the evidence, which can be implemented by the reader in a clinical situation.

gradeof evidence

Benefit

Harm

Cost

Benefits-Harm assessment

Value

Judgments

Policy level

Intervention

This assembled document was then sent out to all con tributing authors for final review to ensure consensus prior to submission for publication.