Abstract：
BACKGROUND: Clinical practice recommendations guide healthcare decisions. This study aims to evaluate the strength and quality of evidence supporting the American Heart Association (AHA)/American Stroke Association (ASA) guidelines for aneurysmal subarachnoid hemorrhage (aSAH) and spontaneous intracerebral hemorrhage (ICH).
METHODS: We reviewed the current AHA/ASA guidelines for aSAH and spontaneous ICH and compared with previous guidelines. Guidelines were classified based on the Class of recommendation (COR) and Level of evidence (LOE). COR signifies recommendation strength (COR 1: Strong; COR 2a: Moderate; COR 2b: Weak; COR 3: No Benefit/Harm), while LOE denotes evidence quality (LOE A: High-Quality; LOE B-NR: Moderate-Quality, Not Randomized; LOE B-R: Moderate-Quality, Randomized; LOE C-EO: Expert Opinion; LOE C-LD: Limited Data).
RESULTS: For aSAH, we identified 84 recommendations across 15 guideline categories. Of these, 31% were classified as COR I, 30% as COR 2a, 17% as COR 2b, and 18% as COR 3. In terms of LOE, 7% were based on LOE A, 10% on LOE B-R, 65% on LOE B-NR, 14% on LOE C-LD, and 5% on LOE C-EO. Compared to previous guidelines, there was a 46% decrease in LOE A, a 45% increase in LOE B, and an 11% decrease in LOE C. For spontaneous ICH, 124 guidelines were identified across 31 guideline categories. Of these, 28% were COR I, 32% COR 2b, and 9% COR 3. For LOE, 4% were based on LOE A, 35% on LOE B-NR, and 42% on LOE C-LD. Compared to previous guidelines, there was a 78% decrease in LOE A, an 82% increase in LOE B, and a 14% increase in LOE C. This analysis highlights that less than a third of AHA/ASA guidelines are classified as the highest class of recommendation, with less than 10% based on the highest LOE.
CONCLUSIONS: Less than a third of AHA/ASA guidelines on aSAH and spontaneous ICH are classified as the highest class of recommendation with less than 10% based on highest LOE. There appears to be a decrease in proportion of guidelines based on highest LOE in most recent guidelines.
METHODS: We reviewed the current AHA/ASA guidelines for aSAH and spontaneous ICH and compared with previous guidelines. Guidelines were classified based on the Class of recommendation (COR) and Level of evidence (LOE). COR signifies recommendation strength (COR 1: Strong; COR 2a: Moderate; COR 2b: Weak; COR 3: No Benefit/Harm), while LOE denotes evidence quality (LOE A: High-Quality; LOE B-NR: Moderate-Quality, Not Randomized; LOE B-R: Moderate-Quality, Randomized; LOE C-EO: Expert Opinion; LOE C-LD: Limited Data).
RESULTS: For aSAH, we identified 84 recommendations across 15 guideline categories. Of these, 31% were classified as COR I, 30% as COR 2a, 17% as COR 2b, and 18% as COR 3. In terms of LOE, 7% were based on LOE A, 10% on LOE B-R, 65% on LOE B-NR, 14% on LOE C-LD, and 5% on LOE C-EO. Compared to previous guidelines, there was a 46% decrease in LOE A, a 45% increase in LOE B, and an 11% decrease in LOE C. For spontaneous ICH, 124 guidelines were identified across 31 guideline categories. Of these, 28% were COR I, 32% COR 2b, and 9% COR 3. For LOE, 4% were based on LOE A, 35% on LOE B-NR, and 42% on LOE C-LD. Compared to previous guidelines, there was a 78% decrease in LOE A, an 82% increase in LOE B, and a 14% increase in LOE C. This analysis highlights that less than a third of AHA/ASA guidelines are classified as the highest class of recommendation, with less than 10% based on the highest LOE.
CONCLUSIONS: Less than a third of AHA/ASA guidelines on aSAH and spontaneous ICH are classified as the highest class of recommendation with less than 10% based on highest LOE. There appears to be a decrease in proportion of guidelines based on highest LOE in most recent guidelines.
摘要：
背景：临床实践建议指导医疗决策。这项研究旨在评估支持美国心脏协会（AHA）/美国中风协会（ASA）动脉瘤性蛛网膜下腔出血（aSAH）和自发性脑出血（ICH）指南的证据的强度和质量。
方法：我们回顾了当前AHA/ASA关于aSAH和自发性ICH的指南，并与以前的指南进行了比较。指南根据推荐类别（COR）和证据水平（LOE）进行分类。COR表示推荐强度（COR1：强；COR2a：中等；COR2b：弱；COR3：无益处/有害），而LOE表示证据质量(LOEA：高质量；LOEB-NR：中等质量，非随机化；LOEB-R：中等质量，随机；LOEC-EO：专家意见；LOEC-LD：有限数据）。
结果：对于aSAH，我们在15个指南类别中确定了84条建议.其中,31%被归类为CORI，30%为COR2a，17%为COR2b，18%为COR3。就LOE而言,7%基于LOEA，LOEB-R的10%，65%的LOEB-NR，在LOEC-LD上为14%，和5%的LOEC-EO。与以前的准则相比，LOEA下降了46%，LOEB增加了45%，LOEC下降11%。对于自发性ICH，在31个指南类别中确定了124个指南。其中,28%是CORI，32%COR2b，和9%COR3。对于LOE，4%基于LOEA，35%的LOEB-NR，和42%的LOEC-LD。与以前的准则相比，LOEA下降了78%，LOEB增加82%，LOEC增加了14%。这项分析强调，不到三分之一的AHA/ASA指南被归类为最高级别的建议，基于最高的LOE，不到10%。
结论：AHA/ASA指南中关于aSAH和自发性ICH的不到三分之一被归类为最高推荐类别，基于最高LOE的比例低于10%。在最近的指南中，基于最高LOE的指南比例似乎有所下降。
方法：我们回顾了当前AHA/ASA关于aSAH和自发性ICH的指南，并与以前的指南进行了比较。指南根据推荐类别（COR）和证据水平（LOE）进行分类。COR表示推荐强度（COR1：强；COR2a：中等；COR2b：弱；COR3：无益处/有害），而LOE表示证据质量(LOEA：高质量；LOEB-NR：中等质量，非随机化；LOEB-R：中等质量，随机；LOEC-EO：专家意见；LOEC-LD：有限数据）。
结果：对于aSAH，我们在15个指南类别中确定了84条建议.其中,31%被归类为CORI，30%为COR2a，17%为COR2b，18%为COR3。就LOE而言,7%基于LOEA，LOEB-R的10%，65%的LOEB-NR，在LOEC-LD上为14%，和5%的LOEC-EO。与以前的准则相比，LOEA下降了46%，LOEB增加了45%，LOEC下降11%。对于自发性ICH，在31个指南类别中确定了124个指南。其中,28%是CORI，32%COR2b，和9%COR3。对于LOE，4%基于LOEA，35%的LOEB-NR，和42%的LOEC-LD。与以前的准则相比，LOEA下降了78%，LOEB增加82%，LOEC增加了14%。这项分析强调，不到三分之一的AHA/ASA指南被归类为最高级别的建议，基于最高的LOE，不到10%。
结论：AHA/ASA指南中关于aSAH和自发性ICH的不到三分之一被归类为最高推荐类别，基于最高LOE的比例低于10%。在最近的指南中，基于最高LOE的指南比例似乎有所下降。
