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  • International Journal of Technology Assessment in Health Care, Volume 24, Issue 3
  • July 2008, pp. 333-341

Analysis of the quality of clinical practice guidelines on established ischemic stroke


Objectives: To catalogue and comparatively assess the quality of Clinical Practice Guidelines (CPG) for ischemic stroke taking into account format and development methodology.

Methods: We performed a comprehensive, systematic bibliographic search of CPGs addressing the management of ischemic stroke. We designed a sensitive strategy, using methodological filters in the following databases: Medline, IME and Lilacs, National Guidelines Clearinghouse, National electronic Library for Health, NICE, Guidelines International Network (GIN), Canadian Medical Association Infobase, development groups such as Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG), Agency for Healthcare Research and Quality (AHRQ), Ministry of Health Singapore, Institute for Clinical Systems Improvement (ICSI); and scientific societies: American Heart Association, American Medical Association, Royal College of Physicians London. We included all CPGs published in English, French, Italian, Portuguese, or Spanish from 1999 to 2005 and excluded those CPGs whose scope was primary prevention and rehabilitation from ischemic stroke. Four researchers independently assessed the structure and methodologies followed in drafting the CPGs using the Changing Professional Practice (CPP) and Appraisal of Guidelines Research & Evaluation (AGREE) instruments.

Results: We retrieved 117 documents; following application of exclusion criteria, twenty-seven CPGs were appraised. With regard to methodological quality (using the AGREE instrument), the domains that scored highest were “Scope and purpose” and “Clarity and presentation.” The lowest scoring domains were “Stakeholder involvement,” “Rigor of development,” and “Applicability.” Most guidelines received an overall score of “would not recommend” (77.8 percent). Finally, based on the CPP instrument, most of the CPGs evaluated were aimed at secondary care and did not provide updating procedures.

Conclusions: The overall quality of the CPGs published for ischemic stroke management did not have minimum methodological quality. Quality improvement has been observed in more recent CPGs and may be due to the publication of new tools such as the AGREE or CPP instruments, as well as international initiatives for CPG improvement.

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1.HP Jr Adams , RJ Adams , T Brott , Stroke Council of the American Stroke Association. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:10561083.

4.EM Antman , J Lau , B Kupelnick , F Mosteller , TC Chalmers . A comparison of results of meta-analyses of randomized controlled trials and recommendations of clinical experts: Treatments for myocardial infarction. JAMA. 1992;268:240248.

7.E Briones , S Vidal , A Navarro , I Marín . Conflicto de interes y guías de práctica clínica en España. Med Clin (Barc). 2006;127:634636.

9.JS Burgers , B Fervers , M Haugh , International assessment of the quality of clinical practice guidelines in oncology using the Appraisal of Guidelines and Research and Evaluation Instrument. J Clin Oncol. 2004;22:20002007.

12.BM Coull , LS Williams , LB Goldstein ; Joint Stroke Guideline Development Committee of the American Academy of Neurology; American Stroke Association. Anticoagulants and antiplatelet agents in acute ischemic stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a division of the American Heart Association). Stroke. 2002;33:19341942.

14.European Resuscitation Council. Part 7. The era of reperfusion. Section 2. Acute stroke. Resuscitation. 2000;46:239252.

15.B Fervers , JS Burgers , MC Haugh , Predictors of high quality clinical practice guidelines: Examples in oncology. Int J Qual Health Care. 2005;17:123132.

16.PB Gorelick , RL Sacco , DB Smith , A review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281:11121120.

17.R Grilli , N Magrini , A Penna , G Mura , A Liberati . Practice guidelines developed by specialty societies: The need for a critical appraisal. Lancet. 2000;355:103106.

18.R Grol . Improving the quality of medical care: Building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001;286:25782585.

21.W Hacke , M Kaste , T Skyhoj Olsen , JM Orgogozo , J Bogousslavsky . European Stroke Initiative (EUSI) recommendations for stroke management. The European Stroke Initiative Writing Committee. Eur J Neurol. 2000;7:607623.

22.RG Hart , RD Bailey . An assessment of guidelines for prevention of ischemic stroke. Neurology. 2002;59:977982.

23.RT Higashida , AJ Furlan , H Roberts , Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology; Technology Assessment Committee of the Society of Interventional Radiology. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34:e3-e4.

30.J Miller , J Petrie . Development of practice guidelines. Lancet. 2000;355:8283.

31.A Navarro Puerto , F Ruiz Romero , A Reyes Domínguez , Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica? Rev Clín Esp. 2005;205:533540.

38.TM Shaneyfelt , MF Mayo-Smith , J Rothwangel . Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999;281:19001905.

39.PG Shekelle , E Ortiz , S Rhodes , Validity of the Agency for Healthcare Research and Quality Clinical Guidelines. How quickly do guidelines become outdated? JAMA. 2001;286:14611467.

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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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