ESOC 2024 | What’s new in ESO guidelines?

Guidelines are one of the centerpieces of the ESO conference and ESO really made a commitment to making guidelines one of the key offerings that they give to members and that they give to the European stroke community. There’s so much research happening at the moment in the stroke space, you can see that from this conference. So many large trials in the late-breaking trial session. It’s difficult for people to keep up and as a clinician on the ground you don’t always have time to read through all of the papers and critically assess them. So really what we try to do with the guidelines is choose those topics are most important to clinicians and we do the hard work. We take the papers, we synthesize them, we critically appraise them, and then we offer recommendations that clinicians can use to try and improve stroke care.

We’re always striving to create new guidelines and it’s not difficult because there’s so much new research in the stroke space. So at the conference this year we have had four guidelines that that we have premiered: we’ve had a guideline on the management of patent foramen ovale, we have had a guideline on the management of basilar artery thrombosis, a guideline on the management of aphasia and communication disorder, and a guideline on the management of intracerebral hemorrhage. The intracerebral hemorrhage guideline is one that we’re especially proud of. Intracerebral hemorrhage there are new trials happening all the time, there have been some practice changing trials presented here at the conference, and what we didn’t want to do is to create a guideline that would become obsolete within weeks of it being published. So we came to an arrangement with the trialists that they would share their data with us while it was still in the process of being peer-reviewed for journals so that our guideline could really be as up to date as possible. It’s been so important because those new trials that we’ve seen today at the conference completely changed the guideline recommendations that we would have made had we not seen those data.

The questions that we see in stroke practice are becoming more complicated, stroke practice is becoming more complicated. Not so long ago guideline questions were really does drug A work versus a placebo. Those aren’t the questions that we have anymore, we know those answers. So as stroke care has become more complex, the guidelines have had to become more sophisticated, so now in our guidelines as well as looking at does a single drug work, we perform analyses called network meta-analyses where we compare drugs against each other to try and see which is the best for a particular situation. We also know that clinical practice isn’t just about giving interventions, so in our guideline work we’ve started to look at things like the accuracy of tests or the predictive ability of tests because those are often the things that most important to patients. Patients want to know, will I get better? Patients want to know, will this test really diagnose my stroke? So we have lots and lots of methodological advances and that’s something that we’re going to continue to work on over the next years.