Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment.

Abstract

BACKGROUND:

Individualised 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.

METHODS:

A 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.

RESULTS:

The 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.

CONCLUSIONS:

We 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.

• Authors: Peter McMeekin, Darren Flynn, Gary A Ford, Helen Rodgers, Jo Gray, Richard G Thomson
• Journal: BMC medical informatics and decision making (BMC Med Inform Decis Mak) Vol. 15 Pg. 90 (Nov 11 2015) ISSN: 1472-6947 [Electronic] England
• PMID: 26560132 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (complications, therapy)
• Decision Support Techniques
• Female
• Humans
• Male
• Middle Aged
• Registries
• Stroke (etiology, therapy)
• Thrombolytic Therapy (adverse effects, standards)