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

McMeekin, Peter, Flynn, Darren, Ford, Gary, Rodgers, Helen, Gray, Joanne and Thomson, Richard G. (2015) Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment. BMC Medical Informatics and Decision Making, 15 (1). p. 90. ISSN 1472-6947

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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.

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.

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.

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.

Item Type: Article
Additional Information: Funding information: This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1241). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The NIHR had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. GAF is supported by an NIHR Senior Investigator award.
Uncontrolled Keywords: Acute Cerebral Infarction, emergency treatment of stroke, thrombolysis, clinical decision support, predictive models
Subjects: A300 Clinical Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Users 6424 not found.
Date Deposited: 17 Nov 2015 14:22
Last Modified: 10 Nov 2021 13:30

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