Evidence map›Paper›PMID 34732070›Full record

SynthesisStroke2022

Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke: Systematic Review and External Validation.

Femke Kremers, Esmee Venema, Martijne Duvekot, Lonneke Yo, Reinoud Bokkers, Geert Lycklama À Nijeholt, Adriaan van Es, Aad van der Lugt, Charles Majoie, James Burke and 4 more

Abstract readSystematic ReviewValidation Study
In one paragraph

Synthesis in Stroke, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 4 pooled it
–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

39 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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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

14 authors.

Femke KremersNeurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.).ORCID 0000-0002-7189-1600
Esmee VenemaNeurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.).ORCID 0000-0003-1631-6635
Martijne DuvekotNeurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.).ORCID 0000-0003-0027-3669
Lonneke YoRadiology, Catharina Medical Center, Eindhoven, the Netherlands (L.Y.).
Reinoud BokkersRadiology, UMCG Groningen Medical Center, the Netherlands (R.B.).ORCID 0000-0001-6130-7311
Geert Lycklama À NijeholtRadiology, Haaglanden Medical Center, The Hague, the Netherlands (G.L.A.N.).
Adriaan van EsRadiology, Leiden Medical Center, the Netherlands (A.v.E.).
Aad van der LugtRadiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.v.d.L.).
Charles MajoieRadiology, Amsterdam Medical Center, the Netherlands (C.M.).
James BurkeNeurology, University of Michigan, Ann Arbor (J.B.).
Bob RoozenbeekNeurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.).
Hester LingsmaPublic Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.).
Diederik DippelNeurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.).
MR CLEAN Registry Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposePrediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice.

methodsWe systematically searched within Medline, Embase, Cochrane, Web of Science, to include prediction models. Models identified from the search were validated in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, which includes all patients treated with endovascular treatment within 6.5 hours after stroke onset in the Netherlands between March 2014 and November 2017. Predictive performance was evaluated according to discrimination (area under the curve) and calibration (slope and intercept of the calibration curve). Good functional outcome was defined as a score of 0-2 or 0-3 on the modified Rankin Scale depending on the model.

resultsAfter screening 3468 publications, 19 models were included in this validation. Variables included in the models mainly addressed clinical and imaging characteristics at baseline. In the validation cohort of 3156 patients, discriminative performance ranged from 0.61 (SPAN-100 [Stroke Prognostication Using Age and NIH Stroke Scale]) to 0.80 (MR PREDICTS). Best-calibrated models were THRIVE (The Totaled Health Risks in Vascular Events; intercept -0.06 [95% CI, -0.14 to 0.02]; slope 0.84 [95% CI, 0.75-0.95]), THRIVE-c (intercept 0.08 [95% CI, -0.02 to 0.17]; slope 0.71 [95% CI, 0.65-0.77]), Stroke Checkerboard score (intercept -0.05 [95% CI, -0.13 to 0.03]; slope 0.97 [95% CI, 0.88-1.08]), and MR PREDICTS (intercept 0.43 [95% CI, 0.33-0.52]; slope 0.93 [95% CI, 0.85-1.01]).

conclusionsThe THRIVE-c score and MR PREDICTS both showed a good combination of discrimination and calibration and were, therefore, superior in predicting functional outcome for patients with ischemic stroke after endovascular treatment within 6.5 hours. Since models used different predictors and several models had relatively good predictive performance, the decision on which model to use in practice may also depend on simplicity of the model, data availability, and the comparability of the population and setting.

Indexed as

Endovascular ProceduresModels, CardiovascularRegistriesHumansIschemic StrokePredictive Value of Testscalibrationischemic strokepopulationprognosispublicationssystematic review

Identifiers

PMID34732070
PMCPMC8884132

What OpenQuestion holds

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Registered trials

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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.