Clinical Guidelines for Acute Stroke Management - Living on the EDge

KEY MESSAGES
iiKey Messages
This second edition of the <strong>Clinical</strong> <strong>Guidelines</strong> <strong>for</strong> <strong>Acute</strong>
<strong>Stroke</strong> <strong>Management</strong> has been developed to provide a
series of evidence-based recommendations related to
acute stroke care. The guidelines should not be seen
as an inflexible recipe <strong>for</strong> stroke care; rather, they
provide a framework that is based on the best
available evidence that can be adapted to local needs,
resources and individual circumstances. Development
of the guidelines has been undertaken by a
multidisciplinary Expert Working Group (EWG) using
methodology consistent with National Health and
Medical Research Council (NHMRC) standards. 2
This summary is designed to provide a quick overview
of the recommendations presented in the guidelines.
However, important in<strong>for</strong>mation pertaining to the
evidence supporting each recommendation as well as
in<strong>for</strong>mation about caveats to the recommendations is
included in a preamble to each section. Because of
this, the recommendations should be read in
conjunction with in<strong>for</strong>mation in the body of the main
document. Further in<strong>for</strong>mation in relation to key
sections is provided in tables of evidence in the
supplement document.
Unlike previous stroke guidelines, each
recommendation is given an overall grading based
on the NHMRC interim levels of evidence pilot. 3 In
addition the levels of evidence of the key references
<strong>for</strong> each guideline along with the actual reference are
included. Where no Level I, II, III or IV evidence was
available but there was sufficient consensus of the
EWG, clinical practice points have been provided.
A summary comparing the first and second editions
is included below along with the levels of evidence
and grading system.
FIRST EDITION SECOND EDITION
(2003) (2007)
Total number of recommendations 96 148
Number of recommendations based on Level I or II studies 26 (27%) 82 (55%)
Number of recommendations based on Level III or IV studies 19 (20%) 14 (10%)
Number of recommendations based on consensus 51 (53%) 52 (35%)
Grading of Recommendations 3
GRADE
A
B
C
D
DESCRIPTION
Body of evidence can be trusted to guide practice
Body of evidence can be trusted to guide practice in most situations
Body of evidence provides some support <strong>for</strong> recommendation(s) but care should be taken in its application
Body of evidence is weak and recommendation must be applied with caution
CLINICAL PRACTICE POINTS
✓
Recommended best practice based on clinical experience and expert opinion.