Cerebrospinal fluid rhinorrhea (ECPG)

- Methods

➡️Methods of development

Stakeholder Involvement: Individuals who were involved in the development process. Included the above-mentioned Rhinology Chief Manager, Rhinology Executive Manager, Assembly Board, Grading Board and Reviewing Board.

Information about target population experiences were not applicable for this topic.

➡️Search Method

Electronic database searched:‎

Pubmed, Medline, Egyptian Knowledge Bank, Medscape, WebMD, Google Scholar

➡️Keywords

CSF rhinorrhea, Endoscopic skull base surgery, skull base repair

The adaptation cycle passed over: set-up phase, adaptation phase (Search and screen, assessment: currency, content, quality & /decision/selection) and finalization phase that included revision and external reviewing.

Time period searched: from 2009 to 2019.

➡️Results

The guidelines were chosen and formulated by the assembly team which consisted of four national otorhinolaryngologists. The International Consensus Statement on Allergy and Rhinology: Endoscopic Skull Base Surgery (ICAR: ESBS), 2019 gained the highest scores as regards currency, contents and quality.

It was graded (GRADE) by 17 experts and reviewed by three expert reviewers to improve quality, gather feedback on draft recommendations.

The external review was done through a rating scale as well as open-ended questions.

➡️Setting: primary, secondary and tertiary care centers & hospitals and related specialties.

Interpretation of strong and conditional recommendation for an intervention

Audience

Strong recommendation

Conditional recommendation

Patients

Most individuals in this situation would want the recommended course of action; only a small proportion would not.

Formal decision aides are not likely to be needed to help individuals make decisions consistent with their values and preferences.

Most individuals in this situation would want the suggested course of action, but many would not.

Clinicians

Most individuals should receive the intervention.

Adherence to the recommendation could be used as a quality criterion or performance indicator.

Different choices will be appropriate for individual patients, who will require assistance in arriving at a management decision consistent with his or her values and preferences. Decision aides may be useful in helping individuals make decisions consistent with their values and preferences.

Policymakers

The recommendation can be adopted as policy in most situations.

Policy-making will require substantial debate and involvement of various stakeholders.

WHO handbook for guideline development – 2nd ed.

Chapter 10, page 129
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to Decision frameworks (GRADE Working Group 2013)

Grade

Definition

High

We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate

We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low

Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.

Very Low

We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

Audience	Strong recommendation	Conditional recommendation
Patients	Most individuals in this situation would want the recommended course of action; only a small proportion would not. Formal decision aides are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Most individuals in this situation would want the suggested course of action, but many would not.
Clinicians	Most individuals should receive the intervention. Adherence to the recommendation could be used as a quality criterion or performance indicator.	Different choices will be appropriate for individual patients, who will require assistance in arriving at a management decision consistent with his or her values and preferences. Decision aides may be useful in helping individuals make decisions consistent with their values and preferences.
Policymakers	The recommendation can be adopted as policy in most situations.	Policy-making will require substantial debate and involvement of various stakeholders.

Grade	Definition
High	We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate	We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low	Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very Low	We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect