Abstract 1122‐000144: Experiences and Strategies Developing an Evidence‐Based Clinical Guideline for Ischemic Stroke in a Middle‐income Setting

Abstract

Introduction: Developing an evidence‐based clinical practice guideline in a middle‐income country is challenging. After a discussion with the stakeholders, we identified and prioritized the need for a clinical guideline about ischemic stroke in our country. We defined stakeholders to anyone who has an interest in the recommendations of the guideline, including patients' representatives, practitioners, policy/decision makers, commissioners of guidelines and other end users. Methods: We developed an evidence‐based guideline using the Grades of Recommendation, Assessment, Development, and Evaluation System (GRADE) approach with a multidisciplinary team including independent methodologists, local and international clinical experts. Systematic step‐by‐step search strategy was used. Four clinical guidelines were identified, quality of development of these guidelines was evaluated using the Appraisal of Guidelines for Research & Evaluation (AGREE II) tool. In the absence of a systematic review in the guideline to answer the clinical question, we proceeded to search for primary studies. The certainty of evidence was classified according to the GRADE system, as high, moderate, low, and very low. Recommendations were classified according to strength, as strong or conditional, and to direction, as in favor or against. Applicability and acceptability were evaluated by the stakeholders and patient’s representatives. External validation by national and international experts in the field was performed. Results: Eight clinical questions related to diagnosis, management, and early rehabilitation for ischemic stroke were formulated. Evidence from systematic reviews and meta‐analysis for every clinical question was discussed, an update was made when needed, and finally, twenty‐eight trustworthy recommendations (8 strong and 20 conditional) were developed. Also, thirty‐eight good practice points and two flowcharts were developed. Conclusions: In a setting with limited resources a high‐quality clinical guideline could be developed using good quality data from the systematic reviews found in previous guidelines. The GRADE approach could be very useful to contextualize the available evidence, making the process feasible and efficient.

Keywords

• Acute Ischemic Stroke Intervention
• Stroke
• Treatment