期刊
STROKE
卷 37, 期 12, 页码 2957-2962出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/01.STR.0000249054.96644.c6
关键词
acute care; acute Rx; acute stroke; clinical decision support; emergency medicine; predictive models; thrombolysis; thrombolytic Rx
资金
- NINDS NIH HHS [K23NS44929, R21NS48225] Funding Source: Medline
Background and Purpose - Many patients with ischemic stroke eligible for recombinant tissue plasminogen activator (rt-PA) are not treated in part because of the risks and benefits perceived by treating physicians. Therefore, we aimed to develop a Stroke-Thrombolytic Predictive Instrument (TPI) to aid physicians considering thrombolysis for stroke. Methods - Using data from 5 major randomized clinical trials (n = 2184) testing rt-PA in the 0- to 6-hour window, we developed logistic regression equations using clinical variables as potential predictors of a good outcome ( modified Rankin Scale score <= 1) and of a catastrophic outcome (modified Rankin Scale score >= 5), with and without rt-PA. The models were internally validated using bootstrap re-sampling. Results - To predict good outcome, in addition to rt-PA treatment, 7 variables significantly affected prognosis and/or the treatment-effect of rt-PA: age, diabetes, stroke severity, sex, previous stroke, systolic blood pressure, and time from symptom onset. To predict catastrophic outcome, only age, stroke severity, and serum glucose were significant; rt-PA treatment was not. For patients treated within 3 hours, the median predicted probability of a good outcome with rt-PA was 42.9% (interquartile range [IQR] = 18.6% to 64.7%) versus 25.3% (IQR = 9.8% to 46.2%) without rt-PA; the median predicted absolute benefit was 12.5% (IQR = 5.1% to 21.0%). The median probability for a catastrophic outcome, with or without, rt-PA was 15.2% (IQR = 8.0% to 31.2%). The area under the receiver-operator characteristic curve was 0.788 for the model predicting good outcome and 0.775 for the model predicting bad outcome. Conclusions - The Stroke-TPI predicts good and bad functional outcomes with and without thrombolysis. Incorporated into a usable tool, it may assist in decision-making.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据