Medical Student Medical College of Georgia Snellville, Georgia, United States
Disclosure(s):
Mehul Mehra: No financial relationships to disclose
Introduction: Clinical practice in neurosurgery, as in all medical fields, has inherent variability. Clinical Practice Guidelines (CPGs) decrease such variation by encouraging resource optimization and thereby improving patient care. To our knowledge, neurosurgical CPGs have not yet been evaluated by metrics designed to ensure CPGs are reported in the utmost quality, such as the framework proposed by the Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group. This investigation aims to comprehensively assess and recognize potential areas for improvement in currently available guidelines for neurosurgical practice.
Methods: After individually completing the associated training, two reviewers extracted and reviewed all 28 guidelines listed on the Congress of Neurological Surgeons website (https://www.cns.org/guidelines/browse-guidelines) in May 2021 and scored them according to the RIGHT guidelines created by Chen et al (2017). RIGHT criteria in the form of 22 distinct statements were broken down into 35 separate items, and guidelines were assigned a “1” if they met the criteria and a “0” if they did not. Subsequent analysis of consensus scores was performed after statistically confirming interrater agreeability.
Results: While none of the 35 RIGHT items derived from 22 statements in the framework were met by all CNS guidelines, 17 (48.6%) were met by greater than 50% of the CNS guidelines. 3 (8.6%) RIGHT items were not met by any CNS guidelines. On average, RIGHT items were met in 14.5 CNS guidelines. 17 (60.7%) of the CNS guidelines adhered to most (>17) RIGHT items. Across the 28 CNS guidelines analyzed, there was a mean adherence of 18.1 RIGHT items.
Conclusion : Overall, numerous valuable and effective RIGHT framework recommendations were addressed by CNS guidelines. By evaluating fidelity to the RIGHT checklist, specific and actionable opportunities for improvement to CNS guideline language and structure can be identified. Therefore, subsequent CPG updates will hopefully enhance and increase evidence-based practice in neurosurgery.
