Guidelines help to facilitate treatment decisions based on available evidence, and also to provide recommendations in areas of uncertainty. In this paper, we compare the recommendations for stroke workup and secondary prevention of ischemic stroke and transient ischemic attack of the American Heart Association (AHA)/American Stroke Association (ASA) with the European Stroke Organization (ESO) guidelines. The primary aim of this paper is to offer clinicians guidance by identifying areas where there is consensus and where consensus is lacking, in the absence or presence of high-level evidence. We compared AHA/ASA with the ESO guideline recommendations for 7 different topics related to diagnostic stroke workup and secondary prevention. We categorized the recommendations based on class and level of evidence to determine whether there were relevant differences in the ratings of evidence that the guidelines used for its recommendations. Finally, we summarized major topics of agreement and disagreement, while also prominent knowledge gaps were identified. In total, we found 63 ESO and 82 AHA/ASA recommendations, of which 38 were on the same subject. Most recommendations are largely similar, but not all are based on high-level evidence. For many recommendations, AHA/ASA and ESO assigned different levels of evidence. For the 10 recommendations with Level A evidence (high quality) in AHA/ASA, ESO only labeled 4 of these as high quality. There are many remaining issues with either no or insufficient evidence, and some topics that are not covered by both guidelines. Most ESO and AHA/ASA Guideline recommendations for stroke workup and secondary prevention were similar. However not all were based on high-level evidence and the appointed level of evidence often differed. Clinicians should not blindly follow all guideline recommendations; the accompanying level of evidence informs which recommendations are based on robust evidence. Topics with lower levels of evidence, or those with recommendations that disagree or are missing, may be an incentive for further clinical research.

中文翻译：

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美国和欧洲缺血性中风和短暂性脑缺血发作诊断检查和二级预防指南建议的比较。


指南有助于根据现有证据做出治疗决策，并在不确定的领域提供建议。在本文中，我们将美国心脏协会 (AHA)/美国卒中协会 (ASA) 与欧洲卒中组织 (ESO) 指南对缺血性卒中和短暂性脑缺血发作的卒中检查和二级预防建议进行比较。本文的主要目的是在缺乏或存在高级证据的情况下，通过确定达成共识和缺乏共识的领域，为临床医生提供指导。我们将 AHA/ASA 与 ESO 指南建议针对与诊断性卒中检查和二级预防相关的 7 个不同主题进行了比较。我们根据证据的类别和级别对建议进行分类，以确定指南用于其建议的证据评级是否存在相关差异。最后，我们总结了一致和分歧的主要主题，同时也指出了突出的知识差距。我们总共发现了 63 条 ESO 和 82 条 AHA/ASA 建议，其中 38 条涉及同一主题。大多数建议大体相似，但并非所有建议都基于高级证据。对于许多建议，AHA/ASA 和 ESO 分配了不同级别的证据。对于 AHA/ASA 中具有 A 级证据（高质量）的 10 条建议，ESO 仅将其中 4 条标记为高质量。还有许多没有证据或证据不足的问题，以及两个指南均未涵盖的一些主题。大多数 ESO 和 AHA/ASA 指南关于中风检查和二级预防的建议是相似的。然而，并非所有这些都基于高水平的证据，并且指定的证据水平往往有所不同。 临床医生不应盲目遵循所有指南建议；随附的证据级别表明哪些建议是基于强有力的证据。证据水平较低的主题，或者建议不同意或缺失的主题，可能会激励进一步的临床研究。