Deep Neck Space Infections (DNSIs)

- Methods

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

Information about target population experiences, views and preferences were applicable for this topic.

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 and Other related specialties Reviewing Board including a nurse.

➡️Search sources included other previous guidelines:

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

➡️Search sources included other previous guidelines:

▪️ Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management,2021.

▪️  Controversies in the management of deep neck space infection in children: an evidence‐based review. Clinical Otolaryngology, 2017.

Time periods searched: from 2017 to 2021.

➡️Results

Three guidelines were assessed by 4 experts Laryngologists and Controversies in the management of deep neck space infection in children: an evidence‐based review. Clinical Otolaryngology, 2017had the highest scores as regards the currency, contents, and quality. It was graded GRADE by 11 expert Laryngologists and reviewed by 3 expert reviewers. (Annexes tables 1-3) [1].

Interpretation of strong and conditional recommendations 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 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.	Policymaking 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

[2] http://www.gradeworkinggroup.org.