Clinical Decision-Making for Thrombolysis of Acute Minor Stroke Using Adaptive Conjoint Analysis

There should be zero practice variability in treatment of stroke. You need to get to objective diagnosis of stroke, remove the variability of the doctor. Protocols are required, do you not understand that simple fact? Protocols exist all over medicine. When the hell are you going to get them delivered for stroke? For this objective starting point ; these exact interventions need to occur. Nothing should be left to chance and interpretation. But that is just my non-medical understanding. Prove me wrong and I can change my position.

Clinical Decision-Making for Thrombolysis of Acute Minor Stroke Using Adaptive Conjoint Analysis 

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Ava L. Liberman, MD, Daniel Pinto, PT, PhD, Sara K. Rostanski, MD, ...

First Published September 13, 2018 Research Article

https://doi.org/10.1177/1941874418799563

Article information

Abstract

Introduction:

There is practice variability in the treatment of patients with minor ischemic stroke with thrombolysis. We sought to determine which clinical factors physicians prioritize in thrombolysis decision-making for minor stroke using adaptive conjoint analysis.

Methods:

We conducted our conjoint analysis using the Potentially All Pairwise RanKings of all possible Alternatives methodology via the 1000Minds platform to design an online preference survey and circulated it to US physicians involved in stroke care. We evaluated 6 clinical attributes: language/speech deficits, motor deficits, other neurological deficits, history suggestive of increased risk of complication from thrombolysis, age, and premorbid disability. Survey participants were asked to choose between pairs of treatment scenarios with various clinical attributes; scenarios automatically adapted based on participants’ prior responses. Preference weights representing the relative importance of each attribute were compared using unadjusted paired t tests. Statistical significance was set at α = .05.

Results:

Fifty-four participants completed the survey; 61% were vascular neurologists and 93% worked in academic centers. All neurological deficits were ranked higher than age, premorbid status, or potential contraindications to thrombolysis. Differences between each successive mean preference weight were significant: motor (31.7%, standard deviation [SD]: 9.5), language/speech (24.1%, SD: 9.6), other neurological deficits (16.6%, SD: 6.4), premorbid status (12.9%, SD: 6.6), age (10.1%, SD: 6.3), and potential thrombolysis contraindication (4.7%, SD: 4.4).

Conclusion:

In a conjoint analysis, surveyed US physicians in academic practice assigned greater weight to motor and speech/language deficits than other neurological deficits, patient age, relative contraindications to thrombolysis, and premorbid disability when deciding to thrombolyse patients with minor stroke.