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(Stroke. 2009;40:1439.)
© 2009 American Heart Association, Inc.

Original Contributions

Postpublication External Review of the Japanese Guidelines for the Management of Stroke 2004

Yukito Shinohara, MD, PhD; Masao Nagayama, MD, PhD Hideki Origasa, PhD

From the Department of Neurology (Y.S.), Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital; the Department of Neurology, Neurocritical Care, and Regional Collaboration (M.N.), Yokohama Stroke and Brain Center; and the Division of Biostatistics and Clinical Epidemiology (H.O.), University of Toyama School of Medicine and Pharmaceutical Sciences, Japan.

Correspondence to Yukito Shinohara, MD, PhD, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo 190-8531, Japan. E-mail yshinoha{at}tachikawa-hosp.gr.jp

Background and Purpose— Many guidelines for management of stroke have been published throughout the world, but no postpublication external review of any set of stroke guidelines by users, using standard checklists, has been reported. The purpose of this article is to present the results of an external review of the Japanese Guidelines for the Management of Stroke 2004, conducted several months postpublication.

Methods— Forty-one evaluators, who had not been involved in developing the guidelines, were selected from representative stroke centers and institutions in Japan. They consisted of 30 physicians including 22 stroke specialists, and 11 nurse practitioners. Three standard checklists, ie, Appraisal of Guidelines for Research and Evaluation (AGREE) instrument, checklist by Shaneyfelt et al, and the Conference on Guideline Standardization (COGS) checklist, were used.

Results— Confidence ratios according to the AGREE checklist were 75%, 77%, and 86% for stroke specialists, physicians other than stroke specialists, and nurse practitioners, respectively. The average scores were 2.98, 3.13, and 3.29, respectively. The confidence ratios according to the checklist by Shaneyfelt et al were 72%, 73% and 86% respectively, and those for the COGS checklist were 66%, 74%, and 91%, respectively.

Conclusions— Although it is impossible to compare our results with those for other stroke guidelines, because none of them has been externally reviewed by users postpublication, our results seem better than those for published guidelines for treatment of other diseases in Japan. These results should be helpful in the process of updating stroke guidelines in Japan and elsewhere.

Key Words: stroke • stroke guidelines • evidence-based medicine • AGREE • COGS • external review of guidelines