目的:指南帮助医生为中风患者提供最佳护理,但由于建议的数量,实施具有挑战性。因此,与建议的适用性有关的实际概述可能会有所帮助。
方法:对发表在科学杂志上的缺血性卒中指南进行了系统评价,涵盖缺血性中风患者的整个急性护理过程。数据提取后,专家对适用性方面的建议进行了评级,也就是说,可操作性,可行性和有效性,李克特的9分量表.一致性定义为≥80%的专家评分≥8分。
结果:共确定了18篇文章,最终提取了48条建议。仅在描述缺血性中风患者的整个急性护理过程时,才包括论文。数据提取和分析显示,该描述的内容和全面性都存在差异。专家就维度可操作性方面的48项建议中的34项(70.8%)达成了一致,可行性为16例(33.3%),有效性为15例(31.3%)。就所有三个维度达成了协议,提出了七个(14.6%)建议:使用中风单元,排除脑出血作为鉴别诊断,静脉溶栓,心电图/心脏评估的表现,无创性血管检查,深静脉血栓形成的预防和他汀类药物的管理,如果需要。
结论:在建议适用性的三个维度上显示出很大的一致性差异。此概述可以指导中风医师改善护理过程并消除可能因有效性和可行性而阻碍实施的障碍。
OBJECTIVE: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance.
METHODS: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9-point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts.
RESULTS: Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non-invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed.
CONCLUSIONS: Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility.