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

Published online by Cambridge University Press:  04 July 2008

Ma Asunción Navarro Puerto ,
Iñaki Gutiérrez Ibarluzea ,
Oscar Guzmán Ruiz ,
Francisco Moniche Alvarez ,
Rocío Gómez Herreros ,
Ruth Engelhardt Pintiado ,
Antonio Reyes Dominguez  and
Ignacio Marín León
Ma Asunción Navarro Puerto
Affiliation:
Valme University Hospital
Iñaki Gutiérrez Ibarluzea
Affiliation:
Osteba-Basque Office for HTA and Nursing University School Vitoria-Gasteiz
Oscar Guzmán Ruiz
Affiliation:
Valme University Hospital
Francisco Moniche Alvarez
Affiliation:
Valme University Hospital
Rocío Gómez Herreros
Affiliation:
Valme University Hospital
Ruth Engelhardt Pintiado
Affiliation:
Valme University Hospital
Antonio Reyes Dominguez
Affiliation:
Valme University Hospital
Ignacio Marín León
Affiliation:
Seville University and Valme University Hospital
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Abstract

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.

Keywords

Clinical practice guidelinesStrokeCerebrovascular accidentAppraisalInternational comparison
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 3 , July 2008 , pp. 333 - 341
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1. Adams, HP Jr, Adams, RJ, Brott, T et al. , 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;34:1056–1083. http://stroke.ahajournals.org/cgi/reprint/34/4/1056.CrossRefGoogle ScholarPubMed
2. Agence Nationale d'Accréditation et d'Evaluation en Santé. Prise en charge initiale des patients adultes atteints d'accident vasculaire cérébral – aspects médicaux 2002. http://www.anaes.fr.Google Scholar
3. Alonso de Leciñana-Cases, M, Pérez-R, GE, Díez-Tejedor, E; on behalf of the Sociedad Iberoamericana de Enfermedad Cerebrovascular (SIECV). Recomendaciones para el tratamiento y prevención del ictus. Rev Neurol. 2004;39:465–4864.Google Scholar
4. Antman, EM, Lau, J, Kupelnick, B, Mosteller, F, Chalmers, TC. A comparison of results of meta-analyses of randomized controlled trials and recommendations of clinical experts: Treatments for myocardial infarction. JAMA. 1992;268:240–248.CrossRefGoogle ScholarPubMed
5. Arboix, A, Chamorro, A, Escudero, D et al. , Malalties Vasculars Cerebrals: Guía Diagnostic I Tractament. Barcelona: Societat Catalana de Neurología. Server Catalá de la Salut; [no date of publication].Google Scholar
6. Brazilian Cerebrovascular Disease Society. First Brazilian consensus for the management of the acute phase of cerebral vascular accidents. Arq Neuropsiquiatr. 2001;59:972–980. http://www.scielo.br/pdf/anp/v60n3A/11149.pdf.Google Scholar
7. Briones, E, Vidal, S, Navarro, A, Marín, I. Conflicto de interes y guías de práctica clínica en España. Med Clin (Barc). 2006;127:634–636.CrossRefGoogle Scholar
8. Burgers, JS, Cluzeau, FA, Hanna, SE, Hunt, C, Grol, R. Characteristics of high-quality guidelines: Evaluation of 86 clinical guidelines developed in ten European countries and Canada. Int J Technol Assess Health Care. 2003;19:148–157.CrossRefGoogle ScholarPubMed
9. Burgers, JS, Fervers, B, Haugh, M et al. , 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;22:2000–2007.CrossRefGoogle ScholarPubMed
10. Canadian Coordinating Office for Health Technology Assessment. CEDAC final recommendation on reconsideration and reasons for recommendation. Insulin glargine (Lantus® – Aventis Phrama Inc.). Edmonton: CCOHTA; 2005.Google Scholar
11. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003. Clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2003;27 (Suppl 2):S1-S152.Google Scholar
12. Coull, BM, Williams, LS, Goldstein, LB et al. ; 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;33:1934–1942. http://www.neurology.org/cgi/reprint/59/1/13.pdf.CrossRefGoogle Scholar
13. Daniel Freeman Memorial Hospital – Tissue plasminogen activator (t-PA) for acute ischemic stroke. Hospital/Medical Center. June 1997 (revised 2002).Google Scholar
14. European Resuscitation Council. Part 7. The era of reperfusion. Section 2. Acute stroke. Resuscitation. 2000;46:239–252.CrossRefGoogle Scholar
15. Fervers, B, Burgers, JS, Haugh, MC, et al. Predictors of high quality clinical practice guidelines: Examples in oncology. Int J Qual Health Care. 2005;17:123–132.CrossRefGoogle ScholarPubMed
16. Gorelick, PB, Sacco, RL, Smith, DB, et al. A review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281:1112–1120.CrossRefGoogle Scholar
17. Grilli, R, Magrini, N, Penna, A, Mura, G, Liberati, A. Practice guidelines developed by specialty societies: The need for a critical appraisal. Lancet. 2000;355:103–106.CrossRefGoogle ScholarPubMed
18. Grol, R. Improving the quality of medical care: Building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001;286:2578–2585.CrossRefGoogle ScholarPubMed
19. Group de Ictus dela Sociedad Valenciana de Neurología. Protocolos de actuación en la fase aguda del ictus isquémico. Valencia: Sociedad Valenciana de Neurología; 1999.Google Scholar
20. Hacke, W, Kaste, M, Bogousslavsky, J et al. ,; European Stroke Initiative Executive Committee and the EUSI Writing Committee. European Stroke Initiative Recommendations for Stroke Management – update 2003. Cerebrovasc Dis. 2003;16:311–337. http://www.eusi-stroke.org.Google Scholar
21. Hacke, W, Kaste, M, Skyhoj Olsen, T, Orgogozo, JM, Bogousslavsky, J. European Stroke Initiative (EUSI) recommendations for stroke management. The European Stroke Initiative Writing Committee. Eur J Neurol. 2000;7:607–623.CrossRefGoogle ScholarPubMed
22. Hart, RG, Bailey, RD. An assessment of guidelines for prevention of ischemic stroke. Neurology. 2002;59:977–982.CrossRefGoogle ScholarPubMed
23. Higashida, RT, Furlan, AJ, Roberts, H et al. , 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.Google Scholar
24. Institute for Clinical Systems Improvement. Diagnosis and initial treatment of ischemic stroke. Private Nonprofit Organization. 2001Oct (revised 2003 Oct). http://www.icsi.org.Google Scholar
25. Jovell, AJ, Navarro-Rubio, MD, Aymerich, M. Guías de práctica clínica. In: Académia de Ciéncies Médiques de Catalunya i Balears, ed. Evidencia científica y toma de decisiones en sanidad. Barelona: Académia de Ciéncies Médiques de Catalunya i Balears; 1999: 221–234.Google Scholar
26. Kothari, RU, Hacke, W, Brott, T et al. , American Heart Association; International Liaison Committee on Resuscitation. Cardiopulmonary resuscitation and emergency cardiovascular care. Stroke. Ann Emerg Med. 2001;37 (Suppl):S137-S144.Google ScholarPubMed
27. Larrue, V, Amarenco, P, Caussanel, JP, et al. [Recommendations for the use of intravenous thrombolytic therapy in cerebrovascular ischemic accident. French Society of Neurovascular Disorders]. Rev Neurol (Paris). 2000;156:1178–1185.Google ScholarPubMed
28. Lohr, KN, Field, MJ. A provisional instrument for assessing clinical practice guidelines. In: Field, MJ, Lohr, KN, eds. Guidelines for clinical practice. From development to use. Washington DC: National Academy Press; 1992.Google Scholar
29. Marzó, M, Alonso, P, Bonfill, X. Guías de práctica clínica en España. Med Clin (Barc). 2002;118 (Suppl 3):30–35.Google Scholar
30. Miller, J, Petrie, J. Development of practice guidelines. Lancet. 2000;355:82–83.CrossRefGoogle ScholarPubMed
31. Navarro Puerto, A, Ruiz Romero, F, Reyes Domínguez, A, et al. Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica? Rev Clín Esp. 2005;205:533–540.CrossRefGoogle Scholar
32. Ng, PW, Huang, CY, Cheung, RT, Wong, KS, Lam, JM; Hong Kong Neurological Society; Hong Kong. Stroke Society. Consensus statement on ischaemic stroke care in Hong Kong. Hong Kong Med J. 2004;10:124–129.Google ScholarPubMed
33. Peeters, A, Cras, P, Bleci, S. Belgian Stroke Council. Proposal of guidelines for acute stroke treatment and management. Acta Neurol Belg. 2002;102:46–48.Google Scholar
34. Royal College of Physicians. National Clinical Guidelines for Stroke 2004. http://www.rcplondon.ac.uk/pubs/books/stroke/.Google Scholar
35. Royal College of Physicians. National Clinical Guidelines for Stroke 2002. http://www.rcplondon.ac.uk/pubs/books/stroke/.Google Scholar
36. Scottish Intercollegiate Guidelines Network. Antithrombotic therapy. A national clinical guideline. National Government Agency [Non-U.S.]. 1999 Mar. http://www.sign.ac.uk.Google Scholar
37. Scottish Intercollegiate Guidelines Network. Management of patients with stroke. Assessment, investigation, immediate management and secondary prevention. A national clinical guideline. National Government Agency [Non-U.S.]. 1997May (revised 1999 Nov). (http://www.sign.ac.uk)Google Scholar
38. Shaneyfelt, TM, Mayo-Smith, MF, Rothwangel, J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999;281:1900–1905.CrossRefGoogle ScholarPubMed
39. Shekelle, PG, Ortiz, E, Rhodes, S, et al. Validity of the Agency for Healthcare Research and Quality Clinical Guidelines. How quickly do guidelines become outdated? JAMA. 2001;286:1461–1467.CrossRefGoogle ScholarPubMed
40. Singapore Ministry of Health. Stroke and transient ischaemic attacks: Assessment, investigation, immediate management and secondary prevention. National Government Agency [Non-U.S.]. 2003 Mar. http://www.moh.gov.sg/mohcorp/publications.aspx?id=16370.Google Scholar
41. Sixth ACCP Consensus Conference on Antithrombotic Therapy. American College of Chest Physicians–Medical Specialty Society. Chest 2001; 119:1 Suppl. 1S-370S. Available in: http://www.chestjournal.org/content/vol119/1/suppl/CrossRefGoogle Scholar
42. Sociedad Española de Neurología. Guía para el tratamiento y prevención del Ictus 2002. Neurología. 2002;17 (Suppl 3).Google Scholar
43. Società Italiana di Neurologia Ictus cerebrale. Linee guida italiane di prevenzione e trattamento. Milano: Società Italiana di Neurologia Ictus cerebrale; 2003.Google Scholar
44. South African Medical Association – Neurological Association of South Africa. Stroke Working Group. Stroke therapy clinical guideline. S Afr Med J. 2000;102:46–48.Google Scholar
45. Thorsen, T, Mäkelä, M, eds. Cambiar la Práctica de los Profesionales. Seville: Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, AETSA; 2002.Google Scholar