European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines

Steiner, Thorsten; Dichgans, Martin; Norrving, Bo; Aamodt, Anne Hege; Berge, Eivind; Christensen, Hanne; Fuentes, Beatriz; Khatri, Pooja; Korompoki, Eleni; Martí‐Fàbregas, Joan; Quinn, Terence J; Toni, Danilo; Zedde, Maria Luisa; Sacco, Simona; Turc, Guillaume

doi:10.1177/23969873211024143

Cited by 19 publications

(43 citation statements)

References 25 publications

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“…This document was developed following the ESO standard operating procedure for guideline development 53 and the GRADE methodology. This guideline aims to inform physicians about evidence available on managing suspected stroke patients with a MSU in the prehospital setting and it aims to assist decision-makers in understanding the benefits of a prehospital advanced management of patients with suspected stroke.…”

Section: Discussionmentioning

confidence: 99%

“…For each PICO question and each outcome, the risk of bias was assessed and quality of evidence rated as high, moderate, low or very low based on the type of available evidence [randomised or non-randomised studies (interventional with experimental design and non-interventional)] and considerations on inconsistency of results, indirectness of evidence, imprecision of results and risk of bias. 53,54 GRADE evidence profiles/summary of findings tables were generated using GRADEpro.8. Each PICO question was addressed separately in distinct sections.…”

Section: Methodsmentioning

confidence: 99%

“…This guideline was initiated by the European Stroke Organisation (ESO) and prepared according to ESO standard operating procedures 53 , which are based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. 54 The ESO Guideline Board and Executive Committee reviewed the intellectual and financial disclosures of the module working group (MWG) members (Supplemental Table 1) and approved the composition of the group, which was co-chaired by the first (SW) and last (G Tsivgoulis) authors.…”

Section: Methodsmentioning

confidence: 99%

“…The direction, strength and formulation of the recommendation was determined according to the GRADE evidence profiles and the ESO-SOP. 53,54 The recommendation does not apply to planned or ongoing trials. Finally, according to the second ESO standard operating procedure 53 , Expert Consensus Statements were added whenever the guideline group considered that there was insufficient evidence available to provide evidence-based recommendations where practical guidance is needed for routine clinical practice.…”

Section: The Recommendation Was Based On a Systematicmentioning

confidence: 99%

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European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Walter

Audebert

Katsanos

et al. 2022

European Stroke Journal

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The safety and efficacy of mobile stroke units (MSUs) in prehospital stroke management has recently been investigated in different clinical studies. MSUs are ambulances equipped with a CT scanner, point-of-care lab, telemedicine and are staffed with a stroke specialised medical team. This European Stroke Organisation (ESO) guideline provides an up-to-date evidence-based recommendation to assist decision-makers in their choice on using MSUs for prehospital management of suspected stroke, which includes patients with acute ischaemic stroke (AIS), intracranial haemorrhage (ICH) and stroke mimics. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and aggregated data meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements are provided where sufficient evidence was not available to provide recommendations based on the GRADE approach. We found moderate evidence for suggesting MSU management for patients with suspected stroke. The patient group diagnosed with AIS shows an improvement of functional outcomes at 90 days, reduced onset to treatment times and increased proportion receiving IVT within 60 min from onset. MSU management might be beneficial for patients with ICH as MSU management was associated with a higher proportion of ICH patients being primarily transported to tertiary care stroke centres. No safety concerns (all-cause mortality, proportion of stroke mimics treated with IVT, symptomatic intracranial bleeding and major extracranial bleeding) could be identified for all patients managed with a MSU compared to conventional care. We suggest MSU management to improve prehospital management of suspected stroke patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: The Recommendation Was Based On a Systematicmentioning

confidence: 99%

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European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Walter

Audebert

Katsanos

et al. 2022

European Stroke Journal

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“…Second, an 'Additional information' paragraph could be added to provide more details on randomized trials mentioned in the first paragraph, to summarize results of observational studies, or to provide information on ongoing or future trials. Third, according to the revised ESO standard operating procedure, 14 an 'Expert consensus statement' paragraph was added whenever the PICO group deemed that the available evidence was insufficient to provide evidence-based recommendations for situations in which practical guidance is needed for routine clinical practice. In that particular case, a pragmatic suggestion was provided.…”

Section: Standardsmentioning

confidence: 99%

European Stroke Organisation (ESO)–European Society for Minimally Invasive Neurological Therapy (ESMINT) expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischemic stroke and anterior circulation large vessel occlusion

Turc

Tsivgoulis

Audebert

et al. 2022

J NeuroIntervent Surg

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Six randomized controlled clinical trials have assessed whether mechanical thrombectomy (MT) alone is non-inferior to intravenous thrombolysis (IVT) plus MT within 4.5 hours of symptom onset in patients with anterior circulation large vessel occlusion (LVO) ischemic stroke and no contraindication to IVT. An expedited recommendation process was initiated by the European Stroke Organisation (ESO) and conducted with the European Society of Minimally Invasive Neurological Therapy (ESMINT) according to ESO standard operating procedure based on the GRADE system. We identified two relevant Population, Intervention, Comparator, Outcome (PICO) questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if insufficient evidence was available to provide recommendations based on the GRADE approach.For stroke patients with anterior circulation LVO directly admitted to a MT-capable center (‘mothership’) within 4.5 hours of symptom onset and eligible for both treatments, we recommend IVT plus MT over MT alone (moderate evidence, strong recommendation). MT should not prevent the initiation of IVT, nor should IVT delay MT. In stroke patients with anterior circulation LVO admitted to a center without MT facilities and eligible for IVT ≤4.5 hours and MT, we recommend IVT followed by rapid transfer to a MT capable-center (‘drip-and-ship’) in preference to omitting IVT (low evidence, strong recommendation). Expert consensus statements on ischemic stroke on awakening from sleep are also provided. Patients with anterior circulation LVO stroke should receive IVT in addition to MT if they have no contraindications to either treatment.

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New horizons in clinical practice guidelines for use with older people

Martin,

Quinn,

Straus

et al. 2024

Age and Ageing

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Globally, more people are living into advanced old age, with age-associated frailty, disability and multimorbidity. Achieving equity for all ages necessitates adapting healthcare systems. Clinical practice guidelines (CPGs) have an important place in adapting evidence-based medicine and clinical care to reflect these changing needs. CPGs can facilitate better and more systematic care for older people. But they can also present a challenge to patient-centred care and shared decision-making when clinical and/or socioeconomic heterogeneity or personal priorities are not reflected in recommendations or in their application. Indeed, evidence is often lacking to enable this variability to be reflected in guidance. Evidence is more likely to be lacking about some sections of the population. Many older adults are at the intersection of many factors associated with exclusion from traditional clinical evidence sources with higher incidence of multimorbidity and disability compounded by poorer healthcare access and ultimately worse outcomes. We describe these challenges and illustrate how they can adversely affect CPG scope, the evidence available and its summation, the content of CPG recommendations and their patient-centred implementation. In all of this, we take older adults as our focus, but much of what we say will be applicable to other marginalised groups. Then, using the established process of formulating a CPG as a framework, we consider how these challenges can be mitigated, with particular attention to applicability and implementation. We consider why CPG recommendations on the same clinical areas may be inconsistent and describe approaches to ensuring that CPGs remain up to date.

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European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines

Cited by 19 publications

References 25 publications

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

European Stroke Organisation (ESO)–European Society for Minimally Invasive Neurological Therapy (ESMINT) expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischemic stroke and anterior circulation large vessel occlusion

New horizons in clinical practice guidelines for use with older people

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