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Mead GE, Sposato LA, Sampaio Silva G, Yperzeele L, Wu S, Kutlubaev M, Cheyne J, Wahab K, Urrutia VC, Sharma VK, Sylaja PN, Hill K, Steiner T, Liebeskind DS, Rabinstein AA. A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization. Int J Stroke 2023; 18:499-531. [PMID: 36725717 PMCID: PMC10196933 DOI: 10.1177/17474930231156753] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. AIMS To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). SUMMARY OF REVIEW Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. CONCLUSION The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.
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Affiliation(s)
- Gillian E Mead
- Usher Institute, University of Edinburgh and Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
- Heart & Brain Lab, Western University, London, ON, Canada
- Robarts Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Laetitia Yperzeele
- Antwerp NeuroVascular Center and Stroke Unit, Antwerp University Hospital, Antwerp, Belgium
- Research Group on Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mansur Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa, Russia
| | - Joshua Cheyne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore
| | - PN Sylaja
- Neurology and Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Kelvin Hill
- Stroke Treatment, Stroke Foundation, Melbourne, VIC, Australia
| | - Thorsten Steiner
- Departments of Neurology, Klinikum Frankfurt Höchst and Heidelberg University Hospital, Frankfurt, Germany
| | - David S Liebeskind
- UCLA Department of Neurology, Neurovascular Imaging Research Core, UCLA Comprehensive Stroke Center, Los Angeles, CA, USA
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Lu S, Luo X, Ni X, Li H, Meng M, Cai Y, Liu Y, Ren M, Sun Y, Chen Y. Reporting quality evaluation of the stroke clinical practice guidelines: a systematic review. Syst Rev 2021; 10:262. [PMID: 34593016 PMCID: PMC8485553 DOI: 10.1186/s13643-021-01805-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To analyze the effectiveness and quality of stroke clinical practice guidelines (CPGs) published in recent years in order to guide future guideline developers to develop better guidelines. PARTICIPANTS No patient involved METHOD: PubMed, China Biology Medicine (CBM), Wanfang, CNKI, and CPG-relevant websites were searched from January 2015 to December 2019 by two researchers independently. The RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was used to assess the reporting quality in terms of domains and items. Then, a subgroup analysis of the results was performed. PRIMARY AND SECONDARY OUTCOME MEASURES RIGHT checklist reporting rate RESULTS: A total of 66 CPGs were included. Twice as many CPGs were published internationally as were published in China. More than half were updated. Most CPGs are published in journals, developed by societies or associations, and were evidence-based grading. The average reporting rate for all included CPGs was 47.6%. Basic information got the highest (71.7% ± 19.7%) reporting rate, while review and quality assurance got the lowest (22.0% ± 24.6%). Then, a cluster analysis between countries, publishing channels, and institutions was performed. There were no statistically significant differences in the reporting quality on the CPGs between publishing countries (China vs. international), publishing channels (journals vs. websites), and institutions (associations vs. non-associations). CONCLUSIONS Current stroke CPGs reports are of low quality. We recommend that guideline developers improve the quality of reporting of key information and improve the management of conflicts of interest. We recommend that guideline developers consider the RIGHT checklist as an important tool for guideline development. TRIAL REGISTRATION https://doi.org/10.17605/OSF.IO/PBWUX .
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Affiliation(s)
- Shuya Lu
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 611731 People’s Republic of China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Xiaojia Ni
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 People’s Republic of China
| | - Haoxuan Li
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
| | - Miaomiao Meng
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
| | - Yefeng Cai
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 People’s Republic of China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Mengjuan Ren
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Yanrui Sun
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Institute of Health Data Science, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, 730000 People’s Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, 730000 Lanzhou, People’s Republic of China
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García-Feijoo P, Isla A, Díez-Tejedor E, Mansilla B, Palpan Flores A, Sáez-Alegre M, Vivancos C. Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors. Neurocirugia (Astur) 2019; 31:7-13. [PMID: 31445797 DOI: 10.1016/j.neucir.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/27/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years. MATERIAL AND METHODS In our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1 year, and at present was measured using the modified Rankin scale (mRS). RESULTS Patient age was shown to be directly related to the mRS (r=0.56; p=0.035) and 37.5% achieved a good outcome (mRS≤3); 78.9% of the interviewed relatives would repeat the surgical decision. CONCLUSIONS We present a 21 patients group where the best outcome was achieved in patients ≤60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients.
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Affiliation(s)
| | - Alberto Isla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | | | - Beatriz Mansilla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | | | | | - Catalina Vivancos
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
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Jeon SB, Park JC, Kwon SU, Kim YJ, Lee S, Kang DW, Kim JS. Intracranial Pressure Soon After Hemicraniectomy in Malignant Middle Cerebral Artery Infarction. J Intensive Care Med 2016; 33:310-316. [PMID: 28523953 DOI: 10.1177/0885066616675598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decompressive hemicraniectomy reduces secondary brain injury related to brain edema and increased intracranial pressure (ICP) in patients with malignant middle cerebral artery infarction (MMI). However, a substantial proportion of patients still die despite hemicraniectomy due to refractory brain swelling. OBJECTIVE We aim to investigate whether ICP measured immediately after hemicraniectomy may indicate decompression effects and predict survival in patients with MMI. METHODS We included 25 patients with MMI who underwent ICP monitoring and brain computed tomography within the first hour of hemicraniectomy. Midline shifts were measured as radiological surrogates of decompression. The Glasgow Coma Scale and pupillary enlargements during the first day after hemicraniectomy were assessed as clinical surrogates of decompression. Long-term survival status at 6 months was used as the final outcome. We analyzed the relationships between early ICP and findings of midline shift, Glasgow Coma Scale, pupillary enlargement, and survival. RESULTS Initial ICP was correlated with mean ICP ( P < .001) and maximal ICP ( P < .001) during the first postoperative day. Intracranial pressure was associated with midline shifts ( P = .009), lower Glasgow Coma Scale scores ( P = .025), and the pupillary enlargement ( P = .015). Sixteen (64.0%) patients survived at 6 months. In a Cox proportional hazard model, elevated ICP was associated with mortality at 6 months (hazard ratio: 1.13; 95% confidence interval: 1.03-1.24; P = .008). CONCLUSION Increase in ICP soon after hemicraniectomy was associated with midline shift, poor neurological status, and mortality in patients with MMI. Measurements of ICP soon after hemicraniectomy may permit earlier interventions as well as more refined clinical assessments.
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Affiliation(s)
- Sang-Beom Jeon
- 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- 2 Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun U Kwon
- 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Jung Kim
- 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- 2 Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Wha Kang
- 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong S Kim
- 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Yu SH, Kim BC, Choi JY, Lee JI, Cho WH, Choi HJ. Addition of Resection of Temporal Muscle and Fascia in Decompressive Craniectomy in the Treatment of Traumatic Brain Injury. Korean J Neurotrauma 2016; 12:84-88. [PMID: 27857913 PMCID: PMC5110924 DOI: 10.13004/kjnt.2016.12.2.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/31/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Decompressive craniectomy (DC) is a widely used surgical procedure for control of severely increased intracranial pressure in various conditions. The goal of this study is to evaluate the effectiveness of the addition of resection of temporalis muscle and fascia in DC particularly in the treatment of traumatic brain injury. METHODS Twenty patients underwent temporalis muscle and fascia resection in addition to conventional DC and duroplasty due to massive brain swelling in a single tertiary hospital from 2013 to 2015 were enrolled. Twenty other patients who received the standard techniques by other neurosurgeons in the same period were gathered for the control group. Postoperative computed tomography (CT) as well as functional outcome in both groups were analyzed retrospectively. RESULTS CT volumetry showed a significant increase of 85.19 mL (p<0.001) of extracranial herniation volume in the research group compared with the control group. Using modified Rankin Scale and Glasgow Outcome Scale, there was no statistically significant difference in functional outcome between the two groups. CONCLUSION Although preliminary, the procedure appears to show a meaningful increase in extracranial herniation volume with minimal masticatory and cosmetic impairment.
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Affiliation(s)
- Seung Han Yu
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Young Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Hwang YH, Jeon JS, Kim YW, Kang DH, Kim YS, Liebeskind DS. Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes. J Neurointerv Surg 2016; 9:21-25. [PMID: 26940314 DOI: 10.1136/neurintsurg-2015-012233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/30/2016] [Accepted: 02/08/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with acute stroke and an extensive ischemic burden at baseline, the prognosis is usually poor despite timely reperfusion. OBJECTIVE To overcome universally poor outcomes in such patients, by applying immediate 'post-reperfusion cooling' in order to reduce reperfusion-related complications, and to describe the clinical and imaging characteristics. METHODS Patients having (1) an acute anterior large vessel occlusive stroke within 4.5 h since last known well, (2) Alberta Stroke Program Early CT Score (ASPECTS) ≤5 on baseline imaging, and (3) targeted temperature management with endovascular cooling after confirmed reperfusion were included in this study. RESULTS Eighteen patients (mean±SD age 59.5±10.9 years, median National Institutes of Health Stroke Scale score of 17, and median ASPECTS of 3) were analyzed. Median lesion volumes at baseline and after treatment were 130.2 and 110.6 mL, respectively. Median time from onset to the start of hypothermia and hypothermia duration were 213 min and 51 h, respectively. Favorable outcome (modified Rankin Scale ≤2) at 3 months was observed in 10 (55.6%) patients. Symptomatic intracranial hemorrhage, malignant brain edema, and pneumonia were observed in 2, 6, and 8 patients, respectively. CONCLUSIONS The use of post-reperfusion cooling as a rescue treatment in patients with substantial ischemia at baseline might improve clinical outcome.
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Affiliation(s)
- Yang-Ha Hwang
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.,Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South
| | - Ji-Su Jeon
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.,Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Dong-Hun Kang
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.,Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Yong-Sun Kim
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - David S Liebeskind
- UCLA Stroke Center, University of California, Los Angeles, California, USA
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