Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
J Neurointerv Surg. 2019 May;11(5):460-463. doi: 10.1136/neurintsurg-2018-014319. Epub 2018 Sep 15.
Twitter is a popular social media platform among physicians. Neurointerventionalists frequently document their lifesaving mechanical thrombectomy cases on Twitter with very favorable results. We fear that there may be some social media publication bias to tweeted mechanical thrombectomy cases with neurointerventionalists being more likely to tweet cases with favorable outcomes. We used these publicly documented cases to analyze post-intervention Twitter-reported outcomes and compared these outcomes with the data provided in the gold standard literature.
Two reviewers performed a search of Twitter for tweeted cases of acute ischemic strokes treated with mechanical thrombectomy. Data were abstracted from each tweet regarding baseline characteristics and outcomes. Twitter-reported outcomes were compared with the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke (HERMES) trial individual patient meta-analysis.
When comparing the tweeted results to HERMES, tweeted cases had a higher post-intervention rate of modified Thrombolysis In Cerebral Infarction (mTICI) scale score of 2c/3 (94% vs 71%, respectively; p<0.0001) and rate of National Institutes of Health Stroke Scale (NIHSS) score ≤2 (81% vs 21%, respectively; p<0.0001). There were no reported complications; thus, tweeted cases also had significantly lower rates of complications, including symptomatic intracerebral hemorrhage (0% vs 4.4%, respectively; p<0.0001), type 2 parenchymal hemorrhage (0% vs 5.1%, respectively; p<0.0001), and mortality (0% vs 15.3%, respectively; p<0.0001).
There is a significant difference between social media and reality even within the 'MedTwitter' sphere, which is likely due to a strong publication bias in Twitter-reported cases. Content on 'MedTwitter', as with most social media, should be accepted cautiously.
Twitter 是医生群体中流行的社交媒体平台。神经介入医师经常在 Twitter 上记录他们挽救生命的机械血栓切除术病例，结果非常理想。我们担心，可能存在一些社交媒体发表偏倚，即神经介入医师更倾向于发布结果良好的机械血栓切除术病例。我们使用这些公开记录的病例来分析机械血栓切除术术后的 Twitter 报告结果，并将这些结果与金标准文献中的数据进行比较。
两名审查员在 Twitter 上搜索接受机械血栓切除术治疗的急性缺血性脑卒中 tweeted 病例。从每条推文汇总基线特征和结果数据。将 Twitter 报告的结果与高效再灌注评估多血管性卒中（HERMES）试验的个体患者荟萃分析进行比较。
与 HERMES 相比，在 tweeted 结果中，机械血栓切除术术后改良脑梗死溶栓（mTICI）评分 2c/3 的比例更高（94%比 71%，分别；p<0.0001），国立卫生研究院卒中量表（NIHSS）评分≤2 的比例更高（81%比 21%，分别；p<0.0001）。没有报告并发症；因此， tweeted 病例的并发症发生率也显著降低，包括症状性颅内出血（0%比 4.4%，分别；p<0.0001）、Ⅱ型实质内出血（0%比 5.1%，分别；p<0.0001）和死亡率（0%比 15.3%，分别；p<0.0001）。
即使在“MedTwitter”领域内，社交媒体和现实之间也存在显著差异，这可能是由于 Twitter 报道病例中存在强烈的发表偏倚。“MedTwitter”上的内容与大多数社交媒体一样，应谨慎接受。
