New Clinical Consensus Statement on Balloon Dilation of the Sinuses

The AAO-HNS Foundation produces two primary quality products, clinical consensus statements (CCSs) and clinical practice guidelines (CPGs), that are used to define best practices, create performance measures, and educate clinicians and the public about current management of common problems. Both products are evidence-based, using the best available evidence to address perceived gaps in care and opportunities for quality improvement. 

A CCS is defined as statements of fact developed by a group of content experts, for which consensus is sought using an explicit, a priori methodology to identify areas of agreement and disagreement. The statements that reach consensus are intended to improve patient care and clinical outcomes, but are not explicit recommendations for action. Instead, their impact on clinical care requires interpretation and value judgments by clinicians and policy makers. The core of a CCS is a series of statements for which a level of agreement (consensus, near consensus, no consensus) is sought using a modified Delphi method, a systematic iterative approach that does not require face-to-face interaction. The current AAO-HNS methodology for CCS development was published in 2015 (Rosenfeld RM, Nnacheta LC, Corrigan MD).

A CPG is defined as recommendations intended to optimize patient care that are informed by a systematic review of the evidence and an assessment of benefit and harms of alternative care options. In contrast to a CCS, the key statements in a CPG call for explicit action by clinicians, with associated levels of obligation (strong recommendation, recommendation, option), an action statement profile, and supporting text. An algorithm is included to show the interrelationship of the key action statements, and secondary products are developed, including an executive summary, plain language summary, and patient decision aids. The current AAO-HNS methodology for CPG development was published in 2013 (Rosenfeld RM, Shiffman RN, Robertson P).

Whether a specific topic is best suited for a CCS or a CPG depends primarily on the level of underlying evidence and the intended target audience. A CPG is most applicable to a multidisciplinary audience with a robust evidence base that includes randomized trials, systematic reviews, and other guidelines. A CCS is most applicable to situations where the evidence base is insufficient for a clinical practice guideline but for which significant practice variations and quality improvement opportunities exist, primarily for an audience of otolaryngologists. A more detailed comparison of characteristics of guidelines versus consensus statements is shown in the table.