颅内动脉瘤破裂是自发性蛛网膜下腔出血的最常见原因。尽管最近在早期发现方面取得了进展,诊断,和适当的治疗,动脉瘤性蛛网膜下腔出血(aSAH)患者的预后仍然较差.众所周知,脑血管痉挛是aSAH最麻烦的并发症,而与脑血管痉挛相关的迟发性脑缺血是aSAH患者不良结局的主要原因。需要以证据为基础的指导方针对预防非常重要,早期发现,和有效管理aSAH诱导的血管痉挛。此外,指南为年轻的医生提供了一个有价值的工具来实践防御医学。然而,方法论,临床适用性,报告清晰度,和指南的偏见必须定期评估。在这项研究中,作者试图评估已发表指南和建议的报告清晰度和方法学质量.
在PubMed中进行了搜索,Scopus,和WebofScience数据库。使用的搜索词是“临床实践指南,\"\"建议,\"\"笔画,\"\"蛛网膜下腔出血,\"和\"血管痉挛\"在所有可能的组合。搜索期从1964年延长至2021年9月,仅限于以英语出版的文献。纳入了所有已发表的关于血管痉挛诊断和治疗的指南和建议。报告指南和建议以外的研究被排除在外。合格的研究由三名盲目的评估者进行评估,采用评估研究与评估指南II(AGREE-II)分析工具。
本研究共评估了10套指南。美国心脏协会/美国中风协会发布的指南发现具有最高的方法学质量和报告清晰度。其次是欧洲卒中组织指南和日本脑中风外科学会发布的英文版日本指南。在当前的分析中,评估者之间的协议是中等的。
这些发现支持以下观点,即在以下领域改进现有指南是可行的:指南和建议制定的严谨性,临床适用性,编辑独立性,和利益相关者的参与。此外,定期更新已发布的指南需要在未来进行改进。
Rupture of an intracranial aneurysm is the most common cause of spontaneous subarachnoid hemorrhage. Despite the recent advances in its early detection, diagnosis, and proper treatment, the outcome of patients experiencing aneurysmal subarachnoid hemorrhage (aSAH) remains poor. It is well known that cerebral vasospasm is the most troublesome complication of aSAH, while delayed cerebral ischemia related to cerebral vasospasm constitutes the major cause of unfavorable outcomes in patients with aSAH. The need for evidence-based
guidelines is of great importance for the prevention, early detection, and efficient management of aSAH-induced vasospasm. Moreover,
guidelines provide young physicians with a valuable tool for practicing defensible medicine. However, the methodology, clinical applicability, reporting clarity, and biases of guidelines must be periodically assessed. In this study, the authors sought to assess the reporting clarity and methodological quality of published guidelines and recommendations.
A search was performed in the PubMed, Scopus, and Web of Science databases. The search terms used were \"clinical practice guidelines,\" \"recommendations,\" \"stroke,\" \"subarachnoid hemorrhage,\" and \"vasospasm\" in all possible combinations. The search period extended from 1964 to September 2021 and was limited to literature published in the English language. All published guidelines and recommendations reporting on the diagnosis and management of vasospasm were included. Studies other than those reporting
guidelines and recommendations were excluded. The eligible studies were evaluated by three blinded raters, employing the Appraisal of Guidelines for Research & Evaluation II (AGREE-II) analysis tool.
A total of 10 sets of
guidelines were evaluated in this study. The American Heart Association/American Stroke Association issued guidelines found to have the highest methodological quality and reporting clarity, followed by the European Stroke Organization guidelines and the English edition of the Japanese guidelines issued by the Japanese Society on Surgery for Cerebral Stroke. The interrater agreement was moderate in the current analysis.
These findings support the idea that improvement of currently existing guidelines is feasible in the following domains: the rigor of guidelines and recommendations development, clinical applicability, editorial independence, and stakeholder involvement. Furthermore, periodic updating of published
guidelines requires improvement in the future.