Table 4

GRADE evidence profile for PICO 2

Certainty assessment							№ of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	MT alone	IVT+	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Good outcome (mRS 0–2 at 90 days)
2	Observational studies49 50	Not serious	Not serious	Not serious	Not serious*	None	121/311 (38.9%)	352/703 (50.1%)	OR 0.63 (0.48 to 0.83)	114 fewer per 1000 (from 176 fewer to 46 fewer)	⨁⨁◯◯ Low	CRITICAL
Excellent outcome (mRS 0–1 at 90 days)
2	Observational studies46 49	Not serious	Not serious	Not serious	Not serious*	None	48/341 (14.1%)	111/449 (24.7%)	OR 0.42 (0.16 to 1.09)	126 fewer per 1000 (from 197 fewer to 16 more)	⨁⨁◯◯ Low	CRITICAL
Reduced disability (≥1 point reduction across all mRS scores at 90 days) – cOR, adjusted analysis
1	Observational study49	Not serious	Not serious	Not serious	Serious*	Strong association			cOR 0.22 (0.07 to 0.69)	-- per 1000 (from -- to --)	⨁⨁◯◯ Low	CRITICAL
All-cause mortality at 90 days
2	Observational studies46 49	Not serious	Not serious	Not serious	Not serious*	None	90/341 (26.4%)	107/449 (23.8%)	OR 1.42 (0.59 to 3.44)	69 more per 1000 (from 82 fewer to 280 more)	⨁⨁◯◯ Low	CRITICAL
Symptomatic intracranial hemorrhage
1	Observational study49	Not serious	Not serious	Not serious	Very serious*	None	1/21 (4.8%)	5/55 (9.1%)	OR 0.50 (0.06 to 4.55)	43 fewer per 1000 (from 85 fewer to 222 more)	⨁◯◯◯ Very low	CRITICAL

*Extremely small number of events.
cOR, common OR; GRADE, Grading of Recommendations, Assessment, Development and Evaluations; IVT, intravenous thrombolysis with alteplase; mRS, modified Rankin Score; MT, mechanical thrombectomy; PICO, Population, Intervention, Comparator, Outcome.