Clinical question and search strategies

National Collaborating Centre for Chronic Conditions (UK)

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National Collaborating Centre for Chronic Conditions (UK). Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA). London: Royal College of Physicians (UK); 2008. (NICE Clinical Guidelines, No. 68.)

See 2019 Partial Update

In May 2019, NICE updated and replaced this guideline with NICE guideline NG128 on stroke and transient ischaemic attack in over 16s. Some of the 2008 recommendations have been retained in the new guideline. This 2008 full guideline includes the evidence supporting the 2008 recommendations. Sections of the guideline CG68 that have been updated are shaded in grey in the PDF.

In May 2019, NICE updated and replaced this guideline with NICE guideline NG128 on stroke and transient ischaemic attack in over 16s. Some of the 2008 recommendations have been retained in the new guideline. This 2008 full guideline includes the evidence supporting the 2008 recommendations. Sections of the guideline CG68 that have been updated are shaded in grey in the PDF.

Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA).

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Appendix AClinical question and search strategies

Question ID	Question wording	Study type filters used	Databases and years
PHAR2a	What is the safety and efficacy of aspirin versus other antiplatelet agents for the treatment of patients with acute ischaemic stroke?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR2b	What is the safety and efficacy of antiplatelet agents versus placebo for the treatment of patients with acute ischaemic stroke?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR2c	What is the safety and efficacy of anticoagulants versus placebo for the treatment of patients with acute ischaemic stroke?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR2d	What is the safety and efficacy of antiplatelet agents versus anticoagulants for the treatment of patients with acute ischaemic stroke?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR3	What is the safety and efficacy of anticoagulants versus placebo or treatment as usual for the treatment of patients with acute venous stroke?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR4	What is the safety and efficacy of anticoagulants versus antiplatelet agents for the treatment of patients with acute arterial dissection?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR5	For patients with acute warfarin associated haemorrhagic stroke, what is the safety and efficacy of i) vitamin K, ii) fresh frozen plasma, iii) prothrombin complex conjugate?	All study types	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR6	What is the safety and efficacy of anticoagulants versus antiplatelet agents or placebo for patients with acute stroke who may require anticoagulation for comorbidities (e.g. atrial fibrillation, prosthetic heart valve (mitral/aortic), deep vein thrombosis or pulmonary embolism)? What is the safety and efficacy of caval filters for deep vein thrombosis or pulmonary embolism?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PHAR7	What is the safety and efficacy of anticoagulants versus antiplatelet agents for the treatment of antiphospholipid syndrome in patients with acute ischaemic stroke?	All study types	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
STAT1	For patients with acute stroke (including haemorrhagic stroke), what is the safety and efficacy of i) initiating statin therapy, ii) continuing statin therapy? Do patients on statins, and who subsequently have a stroke, have reduced mortality and morbidity?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
ADM1	In patients with suspected stroke, what are the benefits of being admitted to specialist care versus a non-specialised unit in terms of recovery time, morbidity and mortality?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
ADM2	Does rapid admission to an acute unit reduce mortality, morbidity and length of hospital stay?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
ASM1	What is the accuracy of a pre-hospital health professional assessment tool/checklist for identifying signs and symptoms of suspected stroke/TIA?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
ASM2	How accurately do scoring systems predict which patients with suspected TIA need to be referred urgently for specialist assessment?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
ASM3	In patients with a suspected minor stroke/TIA, does early versus late expert assessment reduce mortality or morbidity?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
IMAG1	After TIA, which modality (MRI or CT) should be used?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
IMAG2	Which patients with suspected TIA should be referred for urgent brain imaging?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
IMAG3	How quickly should brain imaging be performed following an acute stroke?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
IMAG4	Which patients with suspected stroke/TIA should be referred for urgent carotid imaging?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
NUTRI1	In patients with acute stroke a) what is the accuracy of i) bedside swallowing assessment, ii) videofluoroscopy, iii) fibreoptic endoscopic evaluation of swallowing, and b) how do the results of these assessments affect clinical outcomes?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
NUTRI2	In patients with acute stroke who can take adequate fluids orally, does oral nutritional supplementation reduce mortality and morbidity?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
NUTRI2b	In patients with acute stroke, does fluid therapy reduce mortality and morbidity?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
NUTRI3	In patients with acute stroke who are unable to take adequate fluids orally, does a) early versus late initiation of tube feeding, or b) nasogastric (NG) (including nasal bridles) versus percutaneous endoscopically guided gastrostomy (PEG) (including radiologically inserted gastronomy tubes (RIGs)) reduce mortality and morbidity?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
PREV1	Does withdrawal or modification of oral intake prevent aspiration pneumonia after stroke?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
HYP1	What is the safety and efficacy of the interventions to control hyperglycaemia versus treatment as usual in patients with acute stroke?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
BP1	What is the safety and efficacy of measures to manipulate blood pressure versus treatment as usual in patients with acute stroke?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
OXY1	What is the safety and efficacy of supplemental oxygen therapy versus treatment as usual in patients with acute stroke?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
MOBIL1	Does early mobilisation versus treatment as usual reduce mortality and morbidity in patients with acute stroke?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
MOBIL2	Does placing patients with acute stroke in specific positions reduce mortality and morbidity?	Systematic reviews, RCTs, observational studies	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
REF1	Which patients with primary intracerebral haemorrhage should be referred for surgery?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
REF2	Which patients should be referred for decompressive hemicraniectomy?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007
REF3	Which patients with symptomatic carotid stenosis should be referred for urgent carotid interventional procedures (carotid endarterectomy and stenting)?	Systematic reviews, RCTs	Medline 1950–2007 Embase 1980–2007 Cinahl 1982–2007 Cochrane 1800–2007

: NOTE: The final cut-off date for all searches was 31 October 2007.

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Bookshelf ID: NBK53291

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National Collaborating Centre for Chronic Conditions (UK). Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA). London: Royal College of Physicians (UK); 2008. (NICE Clinical Guidelines, No. 68.) Appendix A, Clinical question and search strategies.
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Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA).

Appendix AClinical question and search strategies

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