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首页> 外文期刊>BMC Medical Informatics and Decision Making >Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment
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Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment

机译：开发决策分析模型以支持有关溶栓治疗的决策和风险沟通

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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.
机译：背景个性化的结果预测可以支持临床决策和共同决策。本文介绍了这种模型的构建，以预测缺血性卒中后是否进行静脉溶栓治疗。方法建立决策分析模型（DAM），以建立溶栓治疗急性缺血性中风的收益和风险之间的可能平衡。脑卒中后三个月的独立性（修正的Rankin评分mRS≤≤2），依赖性（mRS 3至5）和死亡的概率基于中风-溶栓预测仪的校准版本，使用了常规治疗的中风患者的数据在安全实施中风治疗（SITS-UK）注册中心中。未经治疗的患者的预测已使用虚拟国际中风试验档案库（VISTA）的数据进行了验证。使用“卒中监测研究中安全溶栓的实现”（SITS-MOST）数据中的评分模型，纳入了治疗患者出现症状性脑出血的可能性。结果该模型预测了13例患者的特征，有无溶栓情况下3个月内出血，死亡，独立和依赖的可能性。中风溶栓预测仪（S-TPI）的标定（包括其他预测因子）解决了预测不足和过度的问题。通过VISTA数据进行的验证证实，有关治疗效果的假设是正确的。在DAM中，接受治疗的患者中独立性和死亡的C统计量分别为0.793和0.771，未经治疗的VISTA中独立性的C统计量为0.776。结论我们已经制作了一个DAM，可以估计每个患者溶栓的可能获益和风险，随后将其嵌入计算机辅助决策工具中，以支持更好的决策和知情同意。

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