Published online before print October 26, 2006, doi: 10.1161/01.STR.0000250038.93376.78
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(Stroke. 2006;37:2865.)
© 2006 American Heart Association, Inc.
Editorials |
The Stroke-Thrombolytic Predictive Instrument Provides Valid Quantitative Estimates of Outcome Probabilities and Aids Clinical Decision-Making
From the Mayo Clinic College of Medicine, Cerebrovascular Diseases Center, Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ.
Correspondence to Bart M. Demaerschalk, MD, MSc, FRCP(C), Assistant Professor of Neurology, Mayo Clinic College of Medicine, Director, Cerebrovascular Diseases Center, Department of Neurology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ 85259. E-mail Demaerschalk.bart@mayo.edu
Key Words: acute care • acute stroke • emergency medicine • thrombolysis • thrombolytic RX
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Computerized clinical decision support systems are increasingly popular in health sciences and have been demonstrated to improve practitioner performance.1 For an emergency closely related to ischemic stroke, acute myocardial infarction, a thrombolytic predictive instrument was developed for real-time use in emergency medical-service settings to identify patients likely to benefit from thrombolysis and to facilitate the earliest possible use of this therapy.2,3 A similar instrument, designed for ischemic stroke, could also prove to be useful. Thrombolysis for ischemic stroke remains underused even under ideal circumstances. Approximately 40% of emergency physicians in a national survey report that they would not use recombinant tissue plasminogen activator (rt-PA) for stroke, citing the risk of symptomatic intracranial hemorrhage and relative lack of benefit.4 Similar results were reported by Bobrow et al in a survey of the Arizona chapter of the American College of Emergency Physicians. Only 52% of the emergency physicians who responded to the survey indicated that they would endorse rt-PA use for stroke under ideal conditions.5 Physicians’ perceptions of risks and benefits of rt-PA for stroke are not uniformly accurate.6 Merino et al reported that only 11% (95% CI, 0 to 22) of surveyed emergency medicine physicians and neurologists could correctly convey the expected magnitude of beneficial effect of rt-PA, and that only 39% (95% CI, 21 to 57) could accurately report the expected rate of symptomatic and fatal intracranial hemorrhage of rt-PA.6 This misperception may interfere with their willingness to endorse this treatment. It would be helpful to draw a distinction between
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