Decision Making and the Limits of Evidence: A Case Study of Acute Stroke in Pregnancy.

Matthew Boyko, Daniela Iancu, Howard Lesiuk, Dar Dowlatshahi, Michel C F Shamy

Abstract read

In one paragraph

Article in The Neurohospitalist, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it

0cells of the map it votes in

4citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

SiPP (Stroke in Pregnancy and Postpartum): A prospective, observational, international, multicentre study on pathophysiological mechanisms, clinical profile, management and outcome of cerebrovascular diseases in pregnant and postpartum women.European stroke journal · 2020
Article
Ischemic stroke and cerebral venous sinus thrombosis in pregnancy.Handbook of clinical neurology · 2020
Review
Transatlantic Differences in Management of Carotid Stenosis: BRIDGing the Gap in StrokE Management (BRIDGE) Project.The Neurohospitalist · 2018
Article
Acute Ischemic Stroke in Late Pregnancy Treated with Intravenous Thrombolysis and Endovascular Therapy.Case reports in neurology
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Matthew BoykoFaculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Daniela IancuDepartment of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada.

Howard LesiukDepartment of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada.

Dar DowlatshahiDepartment of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada.

Michel C F ShamyDepartment of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

We report the case of a pregnant woman treated for acute ischemic stroke and review the literature on acute stroke treatment in pregnancy. To our knowledge, this is the first case reporting the successful use of intravenous tissue plasminogen activator and a stent retriever for acute stroke in pregnancy. We then use this case to consider the way medical knowledge is used in therapeutic decision making and argue that decision making necessarily extends beyond the limits of clinical trial evidence.

Indexed as

acute strokedecision makingevidencepregnancytherapy

Identifiers

PMID27053984

DOI10.1177/1941874415594120

PMCPMC4802770

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.