We appreciate the insightful comments made by the investigators and largely agree with several important issues and concerns that our article has raised. Ideally, modern clinical practice should be evidence based. Guidelines are a practical means of distilling results from clinical trials to help guide practice and thus serve a very useful role. We agree that conclusions from clinical trials may not always be generalizable and may simplify complex interactions.
Prabhakaran S, Chong JY. Worse Outcomes and Guideline-Driven Care—Reply. Arch Neurol. 2010;67(11):1413-1414. doi:10.1001/archneurol.2010.288