The SITS-MOST registry

Toni, Danilo; Lorenzano, Svetlana; Puca, Emanuele; Prencipe, M.

doi:10.1007/s10072-006-0632-9

Cited by 43 publications

(32 citation statements)

References 2 publications

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“…The inclusion criteria, according to criteria as published by Toni and colleagues, 13 for the present study were as follows:…”

Section: Patient Selectionmentioning

confidence: 99%

“…Completed treatment with a full dose of IVT according to a previously published protocol. 13 Complete documentation of the clinical course, including the initial National Institutes of Health Stroke Scale (NIHSS) score, NIHSS score at 7 days, and modified Rankin Scale (mRS) score at 90 days (90d-mRS). No additional vasculopathy in either a different intracranial territory or the cervical vessels (especially no relevant preceding stenosis).…”

Section: Patient Selectionmentioning

confidence: 99%

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Distance to Thrombus in Acute Middle Cerebral Artery Occlusion

Friedrich

Gawlitza

Schob

et al. 2015

Stroke

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Background and Purpose— In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion. Methods— Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed. Results— DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm ( P <0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA ( P <0.001). Conclusion— DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.

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“…The inclusion criteria, according to criteria as published by Toni and colleagues, 13 for the present study were as follows:…”

Section: Patient Selectionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Distance to Thrombus in Acute Middle Cerebral Artery Occlusion

Friedrich

Gawlitza

Schob

et al. 2015

Stroke

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“…Finally, insights from audit data are dependent on the extent, level of detail and completeness of the data set and may not be fit for purpose, and they cannot address the nuances of decision-making. For instance, the SITS-MOST database 36 is limited to thrombolysed cases only and SSNAP does not collect information on all patient and clinician factors that could influence clinical decision-making.…”

Section: Chapter 3 Research Methodologymentioning

confidence: 99%

“…The ECASS-III 35 trial supported extension of the time window for treatment from 3 to 4.5 hours and the European licence time window was extended. 3 However, according to the Safe Implementation of Thrombolysis in Stroke-Monitoring (SITS-MOST) study, it is common for patients outside the licensing criteria to be treated, 36 suggesting that different clinicians are satisfied with different levels of evidence and/or vary in their decision-making process regarding patient eligibility given the same evidence. Yet little is known about the source or drivers of this variation.…”

mentioning

confidence: 99%

Factors that influence variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke: results of a discrete choice experiment

Thomson

Brún

Flynn

et al. 2017

Health Serv Deliv Res

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BackgroundIntravenous thrombolysis for patients with acute ischaemic stroke is underused (only 80% of eligible patients receive it) and there is variation in its use across the UK. Previously, variation might have been explained by structural differences; however, continuing variation may reflect differences in clinical decision-making regarding the eligibility of patients for treatment. This variation in decision-making could lead to the underuse, or result in inappropriate use, of thrombolysis.ObjectivesTo identify the factors which contribute to variation in, and influence, clinicians’ decision-making about treating ischaemic stroke patients with intravenous thrombolysis.MethodsA discrete choice experiment (DCE) using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted to better understand the influence of patient-related and clinician-related factors on clinical decision-making. An online DCE was developed following an iterative five-stage design process. UK-based clinicians involved in final decision-making about thrombolysis were invited to take part via national professional bodies of relevant medical specialties. Mixed-logit regression analyses were conducted.ResultsA total of 138 clinicians responded and opted to offer thrombolysis in 31.4% of cases. Seven patient factors were individually predictive of the increased likelihood of offering thrombolysis (compared with reference levels in brackets): stroke onset time of 2 hours 30 minutes (50 minutes); pre-stroke dependency modified Rankin Scale score (mRS) of 3 (mRS4); systolic blood pressure (SBP) of 185 mmHg (140 mmHg); stroke severity scores of National Institutes of Health Stroke Scale (NIHSS) 5 without aphasia, NIHSS 14 and NIHSS 23 (NIHSS 2 without aphasia); age 85 years (65 years); and Afro-Caribbean (white). Factors predictive of not offering thrombolysis were age 95 years; stroke onset time of 4 hours 15 minutes; severe dementia (no memory problems); and SBP of 200 mmHg. Three clinician-related factors were predictive of an increased likelihood of offering thrombolysis (perceived robustness of the evidence for thrombolysis; thrombolysing more patients in the past 12 months; and high discomfort with uncertainty) and one factor was predictive of a decreased likelihood of offering treatment (clinicians’ being comfortable treating patients outside the licensing criteria).LimitationsWe anticipated a sample size of 150–200. Nonetheless, the final sample of 138 is good considering that the total population of eligible UK clinicians is relatively small. Furthermore, data from the Royal College of Physicians suggest that our sample is representative of clinicians involved in decision-making about thrombolysis.ConclusionsThere was considerable heterogeneity among respondents in thrombolysis decision-making, indicating that clinicians differ in their thresholds for treatment across a number of patient-related factors. Respondents were significantly more likely to treat 85-year-old patients than patients aged 68 years and this probably reflects acceptance of data from Third International Stroke Trial that report benefit for patients aged > 80 years. That respondents were more likely to offer thrombolysis to patients with severe stroke than to patients with mild stroke may indicate uncertainty/concern about the risk/benefit balance in treatment of minor stroke. Findings will be disseminated via peer-review publication and presentation at national/international conferences, and will be linked to training/continuing professional development (CPD) programmes.Future workThe nature of DCE design means that only a subset of potentially influential factors could be explored. Factors not explored in this study warrant future research. Training/CPD should address the impact of non-medical influences on decision-making using evidence-based strategies.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…26 All patients who fulfilled the Safe Implementation of Thrombolysis in Stroke-Monitoring Study criteria for IV thrombolysis were treated by using rtPA (0.9 mg/kg) within 4.5 hours after ischemic stroke onset. 26,27 Anticoagulation therapy (oral, subcutaneous, or intravenous) and oral administration of acetylsalicylic acid or other antiplatelet agents were used as standard treatment for patients 24 hours after ischemic stroke onset according to guidelines set by the European Stroke Organization.…”

Section: Treatmentmentioning

confidence: 99%