title: National Stroke Association guidelines for the management of transient ischemic attacks.
abstract: OBJECTIVE
  Transient ischemic attacks are common and important harbingers of subsequent stroke. Management varies widely, and most published guidelines have not been updated in several years. We sought to create comprehensive, unbiased, evidence-based guidelines for the management of patients with transient ischemic attacks.
  
  
  METHODS
  Fifteen expert panelists were selected based on objective criteria, using publication metrics that predicted nomination by practitioners in the field. Prior published guidelines were identified through systematic review, and recommendations derived from them were rated independently for quality by the experts. Highest quality recommendations were selected and subsequently edited by the panelists using a modified Delphi approach with multiple iterations of questionnaires to reach consensus on new changes. Experts were provided systematic reviews of recent clinical studies and were asked to justify wording changes based on new evidence and to rate the final recommendations based on level of evidence and quality. No expert was allowed to contribute to recommendations on a topic for which there could be any perception of a conflict of interest.
  
  
  RESULTS
  Of 257 guidelines documents identified by systematic review, 13 documents containing 137 recommendations met all entry criteria. Six iterations of questionnaires were required to reach consensus on wording of 53 final recommendations. Final recommendations covered initial management, evaluation, medical treatment, surgical treatment, and risk factor management.
  
  
  CONCLUSIONS
  The final recommendations on the care of patients with transient ischemic attacks emphasize the importance of urgent evaluation and treatment. The novel approach used to develop these guidelines is feasible, allows for rapid updating, and may reduce bias.
authors.affiliation: Department of Neurology, University of California, San Francisco, CA 94143-0114, USA. clay.johnston@ucsfmedctr.org
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.forename: Mai N
authors.initials: MN
authors.lastname: Nguyen-Huynh
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Schwarz
authors.forename: Kate
authors.initials: K
authors.lastname: Fuller
authors.forename: Christina E
authors.initials: CE
authors.lastname: Williams
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
authors.forename: Steven R
authors.initials: SR
authors.lastname: Levine
authors.forename: Jose
authors.initials: J
authors.lastname: Biller
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Julien
authors.initials: J
authors.lastname: Bogousslavsky
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.forename: Jan
authors.initials: J
authors.lastname: van Gijn
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.forename: Harold P
authors.initials: HP
authors.lastname: Adams
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
mesh_terms: D006287:Health Planning Guidelines; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy*; D012196:Review Literature as Topic; D014481:United States