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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Why Physicians Prescribe Prophylactic Seizure Medications after Intracerebral Hemorrhage: An Adaptive Conjoint Analysis
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Why Physicians Prescribe Prophylactic Seizure Medications after Intracerebral Hemorrhage: An Adaptive Conjoint Analysis

机译：为什么医师在脑出血后规定预防性癫痫发作药物：适应性联合分析

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Background: Seizures are a morbid complication of intracerebral hemorrhage (ICH) and increase the risk for herniation, status epilepticus, and worse patient outcomes. Prophylactic levetiracetam is administered to approximately 40% of patients with ICH. It is unclear which patients are consciously selected for treatment by physicians. We sought to determine how patients are selected for treatment with prophylactic levetiracetam after ICH. Methods: We administered an adaptive conjoint analysis using decision making software to an NIH Stroke Trials Network Working Group. The adaptive conjoint analysis determines the most influential attributes for making a decision in an iterative, algorithm-driven process. We asked respondents which would most influence a decision to administer prophylactic levetiracetam. The attributes and their levels were taken from published phenotypes associated with prophylactic seizure medications and the likelihood of seizures after ICH: hematoma location (lobar or basal ganglia), hematoma volume ( 10 mL), level of consciousness (Glasgow Coma Scale 5-12 or Glasgow Coma Scale 13-15), age ( = 65 years), and race (White or Caucasian or Black/African American). The algorithm terminated when the attributes were ranked from most to least influential. Results: The study sample included 27 respondents who completed the adaptive conjoint analysis out of 42 who responded to the survey with a mean age of 43.4 +/- 9.4 years. The attribute with the greatest weight was hematoma location (30%), followed by reduced level of consciousness (24%), hematoma volume (19%), race (14%), and age (13%). Ranks of attributes were different (P < .001). Conclusions: The decision to administer prophylactic levetiracetam to patients with ICH is driven by lobar hematoma location and depressed level of consciousness. Future research on prophylactic seizure medication could focus on patients most likely to receive it.
机译：背景：癫痫发作是脑出血（ICH）的一种病态并发症，增加了疝气、癫痫持续状态和患者预后恶化的风险。约40%的ICH患者服用预防性左乙拉西坦。目前尚不清楚哪些患者是由医生有意识地选择接受治疗的。我们试图确定ICH后如何选择患者进行预防性左乙拉西坦治疗。方法：我们使用决策软件对NIH中风试验网络工作组进行适应性联合分析。自适应联合分析确定了在迭代算法驱动的过程中做出决策的最具影响力的属性。我们询问了受访者，哪些因素对服用预防性左乙拉西坦的决定影响最大。属性及其水平取自已发表的与预防性癫痫药物和ICH后癫痫发作可能性相关的表型：血肿位置（脑叶或基底节）、血肿体积（10毫升）、意识水平（格拉斯哥昏迷评分5-12或格拉斯哥昏迷评分13-15）、年龄（=65岁）和种族（白人或高加索或黑人/非裔美国人）。当属性从影响最大到影响最小排序时，算法终止。结果：研究样本包括42名平均年龄为43.4+/-9.4岁的受访者，其中27名受访者完成了适应性联合分析。权重最大的属性是血肿位置（30%），其次是意识水平降低（24%）、血肿体积（19%）、种族（14%）和年龄（13%）。属性等级不同（P<0.001）。结论：脑出血患者预防性服用左乙拉西坦的决定是由脑叶血肿位置和意识水平降低决定的。未来关于预防性癫痫药物的研究可能会集中在最有可能服用的患者身上。

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