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BMC Medical Informatics and Decision Making

, 15:90

Clinical decision-making, knowledge support systems, and theory

Abstract

BackgroundIndividualised prediction of outcomes can support clinical and shared decision making. This paper describes the building of such a model to predict outcomes with and without intravenous thrombolysis treatment following ischaemic stroke.

MethodsA decision analytic model DAM was constructed to establish the likely balance of benefits and risks of treating acute ischaemic stroke with thrombolysis. Probability of independence, modified Rankin score mRS ≤ 2, dependence mRS 3 to 5 and death at three months post-stroke was based on a calibrated version of the Stroke-Thrombolytic Predictive Instrument using data from routinely treated stroke patients in the Safe Implementation of Treatments in Stroke SITS-UK registry. Predictions in untreated patients were validated using data from the Virtual International Stroke Trials Archive VISTA. The probability of symptomatic intracerebral haemorrhage in treated patients was incorporated using a scoring model from Safe Implementation of Thrombolysis in Stroke-Monitoring Study SITS-MOST data.

ResultsThe model predicts probabilities of haemorrhage, death, independence and dependence at 3-months, with and without thrombolysis, as a function of 13 patient characteristics. Calibration and inclusion of additional predictors of the Stroke-Thrombolytic Predictive Instrument S-TPI addressed issues of under and over prediction. Validation with VISTA data confirmed that assumptions about treatment effect were just. The C-statistics for independence and death in treated patients in the DAM were 0.793 and 0.771 respectively, and 0.776 for independence in untreated patients from VISTA.

ConclusionsWe have produced a DAM that provides an estimation of the likely benefits and risks of thrombolysis for individual patients, which has subsequently been embedded in a computerised decision aid to support better decision-making and informed consent.

KeywordsAcute Cerebral Infarction Emergency treatment of Stroke Thrombolysis Clinical Decision Support Predictive Models AbbreviationsCOMPASSCOMPuterised decision Aid for Stroke thrombolysis

DAMDecision Analytic Model

IST3The third International Stroke Trial

NIHSSNational Institutes of Health Stroke Scale

mRSmodified Rankin Score

RCTRandomised Controlled Trials

ROCReceiver Operating Curves

SBPSystolic Blood Pressure

SICHSymptomatic IntraCerebral Haemorrhage

S-TPIStroke-Thrombolytic Predictive Instrument

SITS-MOSTSafe Implementation of Thrombolysis in Stroke-Monitoring Study

SITS-UKSafe Implementation of Treatments in Stroke - UK

VISTAVirtual International Stroke Trials Archive

An erratum to this article can be found at http:-dx.doi.org-10.1186-s12911-016-0242-2.

An erratum to this article is available at http:-dx.doi.org-10.1186-s12911-016-0242-2.

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Author: Peter McMeekin - Darren Flynn - Gary A. Ford - Helen Rodgers - Jo Gray - Richard G. Thomson

Source: https://link.springer.com/



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