a confession

is there doubt here?

Brown SGA, Macdonald SPJ, Hankey GJ. Do risks outweigh benefits in thrombolysis for stroke? BMJ. 2013 Aug 29;347(aug29 1):f5215–5.

steroids for spinal cord injury

percutaneous stroke intervention

activated protein C for sepsis

never mind…

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conflictshttp://renegadehealth.com/blog/wp-content/uploads/2012/11/misdiagnosis-small.jpg

misdiagnosis

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eligibility

guidelines

systematic review

s

individual studies

guidelines

http://www.acepnow.com/article/acep-council-votes-reconsider-clinical-policy-use-intravenous-tpa-manage-acute-ischemic-stroke-ed/

Lenzer J. Why we can't trust clinical guidelines. BMJ. 2013 Jun 14;346(jun14 2):f3830–0.

Shinton R. Questions about authorisation of alteplase for ischaemic stroke. The Lancet. 2014 Aug 23;384(9944):659–60.

systematic reviews

Thompson SG. Why sources of heterogeneity in meta-analysis should be investigated. BMJ. 1994 Nov 19;309(6965):1351–5.

Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012 Jun 23;379(9834):2364–72.

individual studies

http://www.ncbi.nlm.nih.gov/pubmed/18815396

http://www.ncbi.nlm.nih.gov/pubmed/12016245

http://www.ncbi.nlm.nih.gov/pubmed/7477192

NINDS

ECASS III

guidelines

systematic reviews

individual studies

image credit: http://thesgem.com/2014/09/sgem85-wont-get-fooled-again-tpa-for-cva/