Authors: Brian L. Hoh, MD, MBA
Alexander A. Khalessi, MD
Nader Pouratian, MD PhD
Healthcare delivery is rapidly evolving, with an intensifying emphasis on evidence-based, value-driven, and standardized care. With an ever-expanding number of clinical studies, it is not only difficult to stay abreast of all key clinical trials but increasingly challenging to judge the quality and value of each study and how it should impact your clinical practice. To address this critical need, the CNS Guidelines Committee develops clinical practice guidelines to comprehensively evaluate the published literature and produce evidence-based recommendations on the most important and relevant topics in neurosurgery that are key to clinical practice.
Guidelines sessions are led by subspecialty experts and members of the CNS Guidelines Committee and guidelines work groups.
The CNS has published over 13 guidelines, ranging from cervical degenerative disease to plagiocephaly to the most recently published guideline on deep brain stimulation for Parkinson disease. An additional nine guidelines are currently in development. Guidelines identify, evaluate, and summarize the highest quality evidence, inform clinical judgment and experience of practitioners, reduce variability and standardize care, promote safety, enhance quality, and increase values. Through these aims, CNS Guidelines have become a critical tool to confront the rapidly changing healthcare environment.
Guidelines are only valuable, however, when their content can be effectively disseminated and the CNS has taken a multi-faceted approach to sharing these critical resources, publishing all guidelines in peer-reviewed journals, on the CNS website, and in the new CNS Guidelines app. Guidelines are also used by payers and other governing institutions to make policy decisions.
In Houston, the 2018 Annual Meeting will feature a Guidelines Session each morning from 7:00-8:30 am, allowing for more effective public presentation and discussion of guidelines and the potential to make an even greater impact. On Monday, guidelines for the acute cervical and thoracolumbar spine trauma will be critically assessed. On Tuesday, cerebrovascular experts will review guidelines on the management of aneurysms, arteriovenous malformations, and ischemic stroke. On Wednesday, guidelines on skull base tumors will be discussed, including vestibular schwannomas, chordomas, and malignant skull base tumors. These sessions, led by members of the Guidelines Committee and the work groups who developed the guidelines, have been among the most well-attended events at the annual meeting. The standing room only crowds and lively discussions attest to their value and success.
1 Brooks et al. The Impact of Guidelines on Clinical Practice Survey of the Use of Methylprednisolone for Acute Spinal Cord Injury. Neurosurgery. 2016 Sep;79(3): E516-20. doi: 10.1227/NEU.0000000000001341.
The CNS Guidelines: Creating Awareness and Changing Practice
Each CNS Guideline is developed by an expert panel of peers-often including experts from allied fields-using very specific and robust methodology to ensure consistency and reliability. Each guideline has been peer-reviewed by the Joint Guidelines Review Committee, with representatives from the CNS and AANS and external partners to ensure methods, interpretations, and recommendations are methodologically sound and accurate. This resource-intensive effort requires thousands of volunteer hours annually.
Guidelines sessions draw standing room only crowds to hear the latest evidence-based updates.
The positive impact of published guidelines on clinical practice has been well documented in the literature. Brooks et al1 conducted a survey, evaluating the impact of guidelines on clinical practice in neurosurgery, which showed CNS guidelines "do have an impact on physician practice, as evidenced by a high level of awareness, a self-reported impact on physician practice, and self-reported steroid use literature that is consistent with more recently published reports." These results inspire continued significant financial investment by the CNS Foundation and contributing sections.
UPDATES ON CURRENT PRACTICE GUIDELINES
Great new things cannot be accomplished without great new information.
Guidelines for Acute Cervical and Thoracolumbar Spine Trauma
Monday | 7:00 am - 8:30 am
Bizhan Aarabi, Paul M. Arnold, John H. Chi, Sanjay S. Dhall, Daniel J. Hoh, R. John Hurlbert, John E. O'Toole, Patricia B. Raksin, Nicholas Theodore
Cerebrovascular Guidelines: Aneurysms, Arteriovenous Malformations, and Acute Ischemic Stroke
Tuesday | 7:00 am - 8:30 am
Alejandro Berenstein, E. Sander Connolly, Kyle M Fargen, Brian L. Hoh, Christopher P. Kellner, Adnan H. Siddiqui, Babu G. Welch
Guidelines on Skull Base Update
Wednesday | 7:00 am - 8:30 am
Franco DeMonte, Paul A. Gardner, Jeffrey J. Olson, Chirag G. Patil, Gelareh Zadeh