Skip to main content
SpringerLink
Log in

The quality assessment of clinical practice guidelines for intracranial aneurysms: a systematic appraisal

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Intracranial aneurysms are common in adults. The relevant guidelines for patients with intracranial aneurysms aim to standardize the clinical practice and decision making for these patients. However, their management is controversial, and the quality of the guidelines has not been assessed. We aim to evaluate the quality of the guidelines for intracranial aneurysms as well as to compare and analyze the recommendations between different guidelines. Systematic searches were conducted to identify the guidelines for intracranial aneurysms from general electronic and guideline databases. Two independent reviewers identified the guidelines and extracted the data, and four reviewers independently evaluated the eligible guidelines through the AGREE II tool. Agreement among reviewers was measured using the intraclass correlation coefficient. A total of 12 guidelines, which were published from 1997 to 2016, were included. The agreement among reviewers was high (intraclass correlation coefficient, 0.85 (95% CI: 0.8–0.89)). The mean scores of six domains ranged from 16.5 to 57.5% (scope and purpose 57.5% (39–68%); stakeholder 30.8% (19–46%); rigor 31.9% (19–52%); clarity 57.2% (42–79%); applicability 24.9% (16–42%); and editorial independence: 16.5% (0–58%)). Furthermore, 202 recommendations related to intracranial aneurysms were collected from the included guidelines. Of these, 143 reported the quality of evidence and/or strength, and 119 reported both the quality of evidence and the strength. Of the 119 recommendations, there were six class A and 20 class B recommendations based on level III evidence. There were 12 recommendations in which the contents were similar between different guidelines and two recommendations with the opposite contents. The AGREE II scores of the guidelines for intracranial aneurysms were relatively low. The majority of recommendations were rated as classes A and B and based on levels II and III evidence. Approximately a fifth of strong recommendations was based on a low quality of evidence without interpretation or explanation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Schievink WI (1997) Intracranial aneurysms. N Engl J Med 336:28–40

    Article  CAS  PubMed  Google Scholar 

  2. Vlak MH, Algra A, Brandenburg R, Rinkel GJ (2011) Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 10:626–636

    Article  PubMed  Google Scholar 

  3. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V (2009) Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 8:355–369

    Article  PubMed  Google Scholar 

  4. Labovitz DL, Halim AX, Brent B, Boden-Albala B, Hauser WA, Sacco RL (2006) Subarachnoid hemorrhage incidence among Whites, Blacks and Caribbean Hispanics: the Northern Manhattan study. Neuroepidemiology 26:147–150

    Article  CAS  PubMed  Google Scholar 

  5. Shea AM, Reed SD, Curtis LH, Alexander MJ, Villani JJ, Schulman KA (2007) Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003. Neurosurgery 61:1131–1137

    Article  PubMed  Google Scholar 

  6. Korja M, Lehto H, Juvela S, Kaprio J (2016) Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rate. Neurology 87(11):1118–1123

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fukuhara T (2015) Geographical analysis of aneurysmal subarachnoid hemorrhage in Japan utilizing publically-accessible DPC database. PLoS One 10(3):e0122467

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ (2009) Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 8(7):635–642

    Article  PubMed  Google Scholar 

  9. Maslehaty H, Petridis AK, Barth H, Mehdorn HM (2011) Diagnostic value of magnetic resonance imaging in perimesencephalic and nonperimesencephalic subarachnoid hemorrhage of unknown origin. J Neurosurg 114:1003–1007

    Article  PubMed  Google Scholar 

  10. Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A (1994) Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke 25:1342–1347

    Article  CAS  PubMed  Google Scholar 

  11. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43(6):1711–1737

    Article  PubMed  Google Scholar 

  12. Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention; American Heart Association; American Stroke Association (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(8):2368–2400

    Article  PubMed  Google Scholar 

  13. Komotar RJ, Mocco J, Solomon RA, Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J (2008) Lawrence pool memorial research symposium—controversies in the management of cerebral aneurysms. Neurosurgery 62(1):183–193 discussion 193-4

    Article  PubMed  Google Scholar 

  14. Johnston SC, Higashida RT, Barrow DL, Caplan LR, Dion JE, Hademenos G, Hopkins LN, Molyneux A, Rosenwasser RH, Vinuela F, Wilson CB, Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology (2002) Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the committee on cerebrovascular imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke 33(10):2536–2544

    Article  PubMed  Google Scholar 

  15. Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC Jr, Brott T, Hademenos G, Chyatte D, Rosenwasser R, Caroselli C (2000) Recommendations for the management of patients with unruptured intracranial aneurysms: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 31(11):2742–2750

    Article  CAS  PubMed  Google Scholar 

  16. Institute of Medicine (1990) Clinical practice guidelines: directions for a new program. National Academies Press, Washington D.C.

    Google Scholar 

  17. Institute of Medicine (1992) Guidelines for clinical practice: from development to use. National Academies Press, Washington D.C.

    Google Scholar 

  18. Institute of Medicine (1995) Setting priorities for clinical practice guidelines. National Academies Press, Washington D.C.

    Google Scholar 

  19. National Institute for Health and Care Excellence (2005) Coil embolisation of ruptured intracranial aneurysms. National Institute for Health and Care Excellence (NICE), London (UK)

    Google Scholar 

  20. National Institute for Health and Care Excellence (2012) Pipeline embolisation device for the treatment of complex intracranial aneurysms. National Institute for Health and Care Excellence (NICE), London (UK)

    Google Scholar 

  21. National Institute for Health and Care Excellence (2004) Supraorbital minicraniotomy for intracranial aneurysm. National Institute for Health and Care Excellence (NICE), London (UK)

    Google Scholar 

  22. Jeong HW, Seo JH, Kim ST, Jung CK, Suh SI (2014) Clinical practice guideline for the management of intracranial aneurysms. Neurointervention 9(2):63–71

    Article  PubMed  PubMed Central  Google Scholar 

  23. Findlay JM (1997) Current management of aneurysmal subarachnoid hemorrhage guidelines from the Canadian Neurosurgical Society. Can J Neurol Sci 24(2):161–170

    Article  CAS  PubMed  Google Scholar 

  24. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, European Stroke Organization, Organization (2013) European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 35(2):93–112

    Article  PubMed  Google Scholar 

  25. Stroke Screening Prevention Project Committee, National Health Family Planning Commission, P,R.China (2016) Chinese guidance and standard for diagnosis and treatment of aneurysmal subarachnoid hemorrhage. Chin J Cerebrovasc Dis 13(7):384–392 [Chinese]

    Google Scholar 

  26. Canadian Task Force on the Periodic Health Examination (1988) The periodic health examination: 2. 1987 update. Can Med Assoc J 138:618–626

    Google Scholar 

  27. Cook DJ, Guyatt GH, Laupacis A, Sackett DL (1992) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102(4 Suppl):305S–311S

    CAS  PubMed  Google Scholar 

  28. Alonso-Coello P, Irfan A, Solà I, Gich I, Delgado-Noguera M, Rigau D, Tort S, Bonfill X, Burgers J, Schunemann H (2010) The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care 19(6):e58

    PubMed  Google Scholar 

  29. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L, AGREE Next Steps Consortium (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 18:E839–E842

    Article  Google Scholar 

  30. Alexander PE, Bero L, Montori VM, Brito JP, Stoltzfus R, Djulbegovic B, Neumann I, Rave S, Guyatt G (2014) World Health Organization recommendations are often strong based on low confidence in effect estimates. J Clin Epidemiol 67(6):629–634

    Article  PubMed  Google Scholar 

  31. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64(4):401–406

    Article  PubMed  Google Scholar 

Download references

Funding

There is no fund for supporting this research.

Author information

Author notes

  1. Li Qiao and Yang Yingchun contributed equally to this research.

Authors and Affiliations

  1. Department of Neurosurgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen Road, Chengguan District, Lanzhou, 730030, China

    Qiao Li, Yingchun Yang, Yawen Pan, Lei Duan & Hu Yang

Authors
  1. Qiao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yingchun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yawen Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yawen Pan.

Ethics declarations

Conflict of interest

There is no conflict of interest to be disclosed.

Ethical approval

This was a review which did not need to accept the ethical approval.

Informed consent

This was a review which included and evaluated the published guidelines for intracranial aneurysms. We did not enroll the patients. So, there was no informed consent.

Electronic supplementary material

Supplementary file 1

(DOCX 27.0 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Q., Yang, Y., Pan, Y. et al. The quality assessment of clinical practice guidelines for intracranial aneurysms: a systematic appraisal. Neurosurg Rev 41, 629–639 (2018). https://doi.org/10.1007/s10143-017-0905-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-017-0905-1

Keywords

Search

Navigation