# Management of Head and Neck Paragangliomas: AGREE II Appraisal of Clinical Practice Guidelines

## TL;DR

This study evaluates the quality of clinical guidelines for managing rare head and neck tumors called paragangliomas and finds most are low quality.

## Contribution

The novel contribution is a critical appraisal of current clinical practice guidelines for head and neck paragangliomas using the AGREE II tool.

## Key findings

- Only 3 out of 7 evaluated clinical practice guidelines were considered high quality.
- Guidelines performed poorly in stakeholder involvement, evidence-based development, and independence from external influence.
- Interrater reliability among reviewers was good to excellent across all domains.

## Abstract

Clinical practice guidelines (CPGs) have recently been created to help standardize management of head and neck paragangliomas (HNPGLs) given their rarity and anatomic proximity to high-risk structures. The aim was to critically evaluate available CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and to answer whether such guidelines are of sufficient quality.

Electronic guideline databases were systematically searched until December of 2023. The inclusion criteria encompassed all CPGs that provided thorough HNPGL management recommendations. Non-English publications and prior versions of existing guidelines were excluded. Selected, relevant CPGs then were independently rated by four reviewers trained in AGREE II protocols over 23 key items and 6 overarching domains. Intraclass correlation coefficients also were calculated to assess interrater reliability.

Of 523 initially identified records, 7 CPGs met the inclusion criteria. Three CPGs were designated as high quality, with the remaining four considered as low quality. Generally, the CPGs did well in defining scope and purpose (84.33% ± 14.91%) and clearly presenting recommendations (77.98% ± 18.59%). However, the CPGs uniformly struggled in outlining stakeholder involvement (56.15% ± 16.25%), using evidence-based development (50.15% ± 23.64%), offering facile applicability (49.55% ± 17.58%), and delineating independence from outside influence (59.52% ± 39.71%). Interrater reliability was good to excellent across all domains.

Most current CPGs on management of HNPGLs are of low quality and would significantly benefit from incorporating standardized evidence-gathering and recommendation-formation practices, systematic review experts, health economists, patient perspectives, and funding disclosures during future development.