Usher Institute, University of Edinburgh and Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
Int J Stroke. 2023 Jun;18(5):499-531. doi: 10.1177/17474930231156753. Epub 2023 Mar 1.
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.
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).
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.
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.
全球有多个卒中指南。为了综合这些指南并总结现有卒中指南对卒中患者管理的建议，世界卒中组织（WSO）指南委员会在 WSO 的主持下，对现有的指南进行了审查。
系统回顾文献，以确定 2011 年 1 月 1 日以来的卒中指南（不包括一级预防和蛛网膜下腔出血），评估质量（国际指南评估、研究和评价 II 级），列出强烈推荐，并根据卒中护理的可及性（最低限度、基本、高级）判断适用性。
检索发现 15400 个标题；检索到 911 篇文章，由三个小组（急性、二级预防、康复）对 200 篇出版物进行了仔细审查，并从相关指南的最新版本中提取了建议。对于急性治疗，缺血性卒中的指南多于脑出血；建议涉及院前、急诊和急性医院护理。强烈推荐急性缺血性卒中的再灌注治疗。对于二级预防，强烈推荐包括确定病因诊断；管理高血压、体重、糖尿病、血脂和生活方式改变；对于缺血性卒中，管理心房颤动、心脏瓣膜病、左心室和心房血栓、卵圆孔未闭、颅外动脉粥样硬化性大血管疾病、颅内动脉粥样硬化性疾病以及非心源性卒中的抗栓治疗。对于康复，有强烈推荐的组织化卒中单元护理、多学科康复、特定任务训练、健身训练和卒中后障碍的特定干预。大多数建议来自高收入国家，而且大多数建议都没有考虑合并症、资源影响和实施情况。患者和公众参与有限。
本综述确定了一些卒中护理领域存在强烈共识的方面。然而，指南建议存在广泛的重复和冗余。未来的指南制定小组应考虑更密切的合作，以提高效率，让更多有经验的患者参与制定过程，考虑合并症，并就实施情况提供建议。
