[Critical appraisal of stroke guidelines]

Despite the increasing burden of disease and known deficiencies of actual stroke care there is a lack of evidence-based stroke guidelines in Germany. For future guideline development and implementation in Germany, critically appraising internationally available guidelines might be useful.

To identify and evaluate published evidence-based German and English language stroke/cerebrovascular disorder guidelines using the established "German Guideline Appraisal Instrument".

Systematic literature search (published in 1992-2002) using Medline and English-/German language guideline databases. A total of 626 hits resulted in 54 guideline articles. 13 articles (from Australia, Germany, the United Kingdom, Singapore and the USA) fulfilled specific inclusion criteria (recommended for countrywide implementation, complete guidelines for prevention and/or diagnostic/treatment and/or rehabilitation). The systematic guideline appraisal consisted of a) the assessment of the methodological quality using the established "German Guideline Appraisal Instrument" attributing scores and ranking the guidelines according to their overall quality; b) the systematic documentation of appraisal using structured abstracts.

The methodological quality of "content and form" (10-17 of a total of 17 points) of the 13 guidelines was comparable. Regarding the domains of the "quality of the development process" (the guidelines achieved 4-15 of 17 points) and "guideline applicability" (0-3 of 6 points), though, the appraised guidelines varied impressively. The 6 best guidelines (> or = 25 of a total of 40 points) were characterized by explicitly linking recommendations and supporting evidence, by expert reviews of the guidelines prior to publication, and the provision of instructions for guideline implementation.

None of the 13 appraised guidelines covered all key methodological quality criteria. The analysis shows, however, that it should be possible to compile a methodologically sound stroke guideline by using those parts of the different appraised guidelines that fitted the quality criteria best.