ReviewJournal of the neurological sciences2017
A systematic comparison of key features of ischemic stroke prevention guidelines in low- and middle-income vs. high-income countries.
Review in Journal of the neurological sciences, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Clinical care in interstitial lung disease: a critical appraisal of clinical guidance documents.European respiratory review : an official journal of the European Respiratory Society · 2025Pooled it
- A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization.International journal of stroke : official journal of the International Stroke Society · 2023Pooled it
- Pooled it
- Systematic Review of Existing Stroke Guidelines: Case for a Change.BioMed research international · 2022Pooled it
- Quality of stroke guidelines in low- and middle-income countries: a systematic review.Bulletin of the World Health Organization · 2021Pooled it
- Impact of Pneumonia on Rehabilitation Outcomes: A Large Observational Study.Archives of rehabilitation research and clinical translation · 2026Article
- Challenges in the Management of Stroke in Intensive Care Units in Low- and Middle-Income Countries.Neurocritical care · 2025Review
- Growing Data science Research in Africa to Stimulate Progress (GRASP) program: Rationale and overview.Equity neuroscience · 2025Article
- Global variation in antibiotic prescribing guidelines and the implications for decreasing AMR in the future.Frontiers in pharmacology · 2025Review
- Addressing disparities in the global epidemiology of stroke.Nature reviews. Neurology · 2024Review
- Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission.The Lancet. Neurology · 2023Review
- Applicability of European Society of Cardiology guidelines according to gross national income.European heart journal · 2023Article
- Influence of recent direct-to-EVT trials on practical decision-making for the treatment of acute ischemic stroke patients.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2022Article
- Prevention and control of non-communicable diseases in antenatal, intrapartum, and postnatal care: a systematic scoping review of clinical practice guidelines since 2011.BMC medicine · 2022Article
- Factors Associated with the Quality and Transparency of National Guidelines: A Mixed-Methods Study.International journal of environmental research and public health · 2022Article
- Primary stroke prevention worldwide: translating evidence into action.The Lancet. Public health · 2022Review
- Stroke in Africa: profile, progress, prospects and priorities.Nature reviews. Neurology · 2021Review
- Gaps in COPD Guidelines of Low- and Middle-Income Countries: A Systematic Scoping Review.Chest · 2021Article
- Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review.Journal of multidisciplinary healthcare · 2021Article
- Quality of care for ischemic stroke in China vs India: Findings from national clinical registries.Neurology · 2018Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
background and purposeImplementation of contextually appropriate, evidence-based, expert-recommended stroke prevention guideline is particularly important in Low-Income Countries (LMICs), which bear disproportional larger burden of stroke while possessing fewer resources. However, key quality characteristics of guidelines issued in LMICs compared with those in High-Income Countries (HICs) have not been systematically studied. We aimed to compare important features of stroke prevention guidelines issued in these groups.
methodsWe systematically searched PubMed, AJOL, SciELO, and LILACS databases for stroke prevention guidelines published between January 2005 and December 2015 by country. Primary search items included: "Stroke" and "Guidelines". We critically appraised the articles for evidence level, issuance frequency, translatability to clinical practice, and ethical considerations. We followed the PRISMA guidelines for the elaboration process.
resultsAmong 36 stroke prevention guidelines published, 22 (61%) met eligibility criteria: 8 from LMICs (36%) and 14 from HICs (64%). LMIC-issued guidelines were less likely to have articulation of recommendations (62% vs. 100%, p=0.03), involve high quality systematic reviews (21% vs. 79%, p=0.006), have a good dissemination channels (12% vs 71%, p=0.02) and have an external reviewer (12% vs 57%, p=0.07). The patient views and preferences were the most significant stakeholder considerations in HIC (57%, p=0.01) compared with LMICs. The most frequent evidence grading system was American Heart Association (AHA) used in 22% of the guidelines. The Class I/III and Level (A) recommendations were homogenous among LMICs.
conclusionsThe quality and quantity of stroke prevention guidelines in LMICs are less than those of HICs and need to be significantly improved upon.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.