Article type
Year
Abstract
Background: Clinical practice guidelines (CPGs) could improve clinical practice and should include systematic reviews (SRs) as their main ingredients in order to be evidence based.
Objectives: To assess the degree of concordance of the conclusions of all SRs available on acute ischaemic stroke drug treatments with CPGs about this topic.
Methods: The search for SRs was performed in the electronic databases MEDLINE (1966 to 1/1/2006), EMBASE (1974 to 5/5/2005) and The Cochrane Library (2005, Issue 4). The search for CPGs was performed for the period (1999 to 6/2004), in MEDLINE, the National Guidelines Clearinghouse, the National electronic Library for Health (NeLH), the Canadian Medical Association Infobase Clinical Practice Guidelines, the Scottish Intercollegiate Guidelines Network (SIGN), and in several Spanish databases. Two reviewers independently assessed all the papers identified for eligibility. Data extraction was performed using a standard form. The quality of SRs was assessed using the SIGN criteria and the quality of guidelines by using the AGREE (Appraisal of Guidelines for Research and Education) instrument (Area Three: rigour in elaboration). The quality of SRs and CPGs was classified in four categories: very low, low, high and very high quality. We compared the recommendations of the high quality CPGs with the main conclusions of the high and very high quality SRs. An agreement of 90% or more between SRs and CPGs was considered acceptable.
Results: Thirty SRs (21 Cochrane reviews) on drug treatments for ischaemic stroke and 41 CPGs were included. Quality was very high in two (Cochrane reviews) and three CPGs, high in 25 SRs (18 Cochrane reviews) and three CPGs, low in two SRs (one Cochrane review) and 16 CPGs, very low in one SR and 19 CPGs. The main conclusions driven from the six high/very high quality CPGs identified were in agreement with the recommendations about drug treatment from the 27 high/very high SRs.
Conclusions: SRs, and specifically Cochrane reviews, provide a reliable source to build good quality CPGs on drug treatment in acute stroke. The quality of most of the CPGs on stroke is low. Further collaboration should be established between systematic reviewers and clinical practice guideline authors in order to improve the awareness and the quality of CPGs.
Objectives: To assess the degree of concordance of the conclusions of all SRs available on acute ischaemic stroke drug treatments with CPGs about this topic.
Methods: The search for SRs was performed in the electronic databases MEDLINE (1966 to 1/1/2006), EMBASE (1974 to 5/5/2005) and The Cochrane Library (2005, Issue 4). The search for CPGs was performed for the period (1999 to 6/2004), in MEDLINE, the National Guidelines Clearinghouse, the National electronic Library for Health (NeLH), the Canadian Medical Association Infobase Clinical Practice Guidelines, the Scottish Intercollegiate Guidelines Network (SIGN), and in several Spanish databases. Two reviewers independently assessed all the papers identified for eligibility. Data extraction was performed using a standard form. The quality of SRs was assessed using the SIGN criteria and the quality of guidelines by using the AGREE (Appraisal of Guidelines for Research and Education) instrument (Area Three: rigour in elaboration). The quality of SRs and CPGs was classified in four categories: very low, low, high and very high quality. We compared the recommendations of the high quality CPGs with the main conclusions of the high and very high quality SRs. An agreement of 90% or more between SRs and CPGs was considered acceptable.
Results: Thirty SRs (21 Cochrane reviews) on drug treatments for ischaemic stroke and 41 CPGs were included. Quality was very high in two (Cochrane reviews) and three CPGs, high in 25 SRs (18 Cochrane reviews) and three CPGs, low in two SRs (one Cochrane review) and 16 CPGs, very low in one SR and 19 CPGs. The main conclusions driven from the six high/very high quality CPGs identified were in agreement with the recommendations about drug treatment from the 27 high/very high SRs.
Conclusions: SRs, and specifically Cochrane reviews, provide a reliable source to build good quality CPGs on drug treatment in acute stroke. The quality of most of the CPGs on stroke is low. Further collaboration should be established between systematic reviewers and clinical practice guideline authors in order to improve the awareness and the quality of CPGs.