Influence of Guidelines in Endovascular Therapy Decision Making in Acute Ischemic Stroke: Insights From UNMASK EVT.

Kashani, Nima; Ospel, Johanna M; Menon, Bijoy K; Saposnik, Gustavo; Almekhlafi, Mohammed; Sylaja, Pillai N; Campbell, Bruce C V; Heo, Ji-Hoe; Mitchell, Peter J; Cherian, Mathew; Turjman, Francis; Kim, Byungmoon; Fischer, Urs; Wilson, Alexis T; Baxter, Blaise; Rabinstein, Alejandro; Yoshimura, Shinichi; Hill, Michael D; Goyal, Mayank (2019). Influence of Guidelines in Endovascular Therapy Decision Making in Acute Ischemic Stroke: Insights From UNMASK EVT. Stroke, 50(12), pp. 3578-3584. Wolters Kluwer Health 10.1161/STROKEAHA.119.026982

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Background and Purpose- The American Heart Association and the American Stroke Association guidelines for early management of patients with ischemic stroke offer guidance to physicians involved in acute stroke care and clarify endovascular treatment indications. The purpose of this study was to assess concordance of physicians' endovascular treatment decision-making with current American Heart Association and the American Stroke Association stroke treatment guidelines using a survey-approach and to explore how decision-making in the absence of guideline recommendations is approached. Methods- In an international cross-sectional survey (UNMASK-EVT), physicians were randomly assigned 10 of 22 case scenarios (8 constructed with level 1A and 11 with level 2B evidence for endovascular treatment and 3 scenarios without guideline coverage) and asked to declare their treatment approach (1) under their current local resources and (2) assuming there were no external constraints. The proportion of physicians offering endovascular therapy (EVT) was calculated. Subgroup analysis was performed for different specialties, geographic regions, with regard to physicians' age, endovascular, and general stroke treatment experience. Results- When facing level 1A evidence, participants decided in favor of EVT in 86.8% under current local resources and in 90.6% under assumed ideal conditions, that is, 9.4% decided against EVT even under assumed ideal conditions. In case scenarios with level 2B evidence, 66.3% decided to proceed with EVT under current local resources and 69.7% under assumed ideal conditions. Conclusions- There is potential for improving thinking around the decision to offer endovascular treatment, since physicians did not offer EVT even under assumed ideal conditions in 9.4% despite facing level 1A evidence. A majority of physicians would offer EVT even for level 2B evidence cases.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1524-4628

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

15 Jan 2020 11:32

Last Modified:

15 Jan 2020 11:32

Publisher DOI:

10.1161/STROKEAHA.119.026982

PubMed ID:

31684847

Uncontrolled Keywords:

cross-sectional studies decision-making physicians stroke treatment

BORIS DOI:

10.7892/boris.137738

URI:

https://boris.unibe.ch/id/eprint/137738

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