Neurology

Cayuga Neurologic Services has highly trained, experienced neurologists who specialize in diagnosing and treating disorders of the central nervous system, comprising the brain, the spinal cord, and the nerves.

Stroke

Clinical Practice Guidelines

Clinical Practice Guidelines (CPGs) drive for best practice for stroke care. They are compiled by experts in the field and organized by Classes of Recommendation (COR) and levels of evidence (LOE). CPGs create the framework upon which the Stroke Program is built: policies, procedures, order sets, and algorithms all stem from the evidence-based recommendations found within them

What are Clinical Practice Guidelines?

Clinical Practice Guidelines (CPGs) drive for best practice for stroke care. They are compiled by experts in the field and organized by Classes of Recommendation (COR) and levels of evidence (LOE). CPGs create the framework upon which the Stroke Program is built: policies, procedures, order sets, and algorithms all stem from the evidence-based recommendations found within them.

What are COR and LOE, really?

COR determines to what extent the benefits of a particular recommendation outweigh the risks or vice versa; for example, giving thrombolytics to an eligible patient is the highest level of recommendation, I, as its benefits have been shown to outweigh Its risks and its one of two definitive treatments for ischemic stroke. On the other hand, starting a Foley catheter on every patient is a 3H, shown repeatedly to cause harm and thus to be avoided.

LOE determines the strength of the supporting evidence, A representing a large, multi-center randomized controlled trial (RCT) all the way down to CEO, which is expert opinion. However, just because a recommendation is CEO, doesn’t mean that it’s worthless. For example, educating emergency dispatchers on signs of stroke is CEO because it will never lend itself well—or ethically—to an RCT: e.g., you would never tell Tompkins County to educate their dispatchers and Cortland County not to as an experimental model to prove a point; it would be unethical and ridiculous.