Marquette University, Minneapolis, Minnesota.
University of Chicago, Chicago, Illinois.
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104628. doi: 10.1016/j.jstrokecerebrovasdis.2019.104628. Epub 2020 Feb 6.
Seizures are a morbid complication of intracerebral hemorrhage (ICH) and increase the risk for herniation, status epilepticus, and worse patient outcomes. Prophylactic levetiracetam is administered to approximately 40% of patients with ICH. It is unclear which patients are consciously selected for treatment by physicians. We sought to determine how patients are selected for treatment with prophylactic levetiracetam after ICH.
We administered an adaptive conjoint analysis using decision making software to an NIH Stroke Trials Network Working Group. The adaptive conjoint analysis determines the most influential attributes for making a decision in an iterative, algorithm-driven process. We asked respondents which would most influence a decision to administer prophylactic levetiracetam. The attributes and their levels were taken from published phenotypes associated with prophylactic seizure medications and the likelihood of seizures after ICH: hematoma location (lobar or basal ganglia), hematoma volume (<=10 mL or >10 mL), level of consciousness (Glasgow Coma Scale 5-12 or Glasgow Coma Scale 13-15), age (<65 or ≥65 years), and race (White or Caucasian or Black/African American). The algorithm terminated when the attributes were ranked from most to least influential.
The study sample included 27 respondents who completed the adaptive conjoint analysis out of 42 who responded to the survey with a mean age of 43.4 ± 9.4 years. The attribute with the greatest weight was hematoma location (30%), followed by reduced level of consciousness (24%), hematoma volume (19%), race (14%), and age (13%). Ranks of attributes were different (P < .001).
The decision to administer prophylactic levetiracetam to patients with ICH is driven by lobar hematoma location and depressed level of consciousness. Future research on prophylactic seizure medication could focus on patients most likely to receive it.
癫痫发作是脑出血（ICH）的一种严重并发症，增加了脑疝、癫痫持续状态和更差的患者预后的风险。约 40%的脑出血患者预防性给予左乙拉西坦。目前尚不清楚哪些患者是医生有意识地选择进行治疗的。我们试图确定ICH 后患者是如何被选择预防性给予左乙拉西坦治疗的。
我们使用决策软件对 NIH 卒中试验网络工作组进行了适应性联合分析。适应性联合分析通过迭代、算法驱动的过程确定决策的最具影响力的属性。我们询问受访者哪些因素最能影响给予预防性左乙拉西坦的决定。属性及其水平取自与预防性抗癫痫药物和脑出血后癫痫发作的可能性相关的已发表表型：血肿位置（脑叶或基底节）、血肿体积（<=10 mL 或 >10 mL）、意识水平（格拉斯哥昏迷量表 5-12 或格拉斯哥昏迷量表 13-15）、年龄（<65 或>=65 岁）和种族（白种人或高加索人或黑种人/非裔美国人）。当属性从最具影响力到最不具影响力进行排名时，算法终止。
研究样本包括 27 名完成适应性联合分析的受访者，其中 42 名受访者对调查做出了回应，平均年龄为 43.4±9.4 岁。权重最大的属性是血肿位置（30%），其次是意识水平降低（24%）、血肿体积（19%）、种族（14%）和年龄（13%）。属性的排名不同（P<.001）。
ICH 患者给予预防性左乙拉西坦的决定取决于脑叶血肿位置和意识水平降低。预防性抗癫痫药物的未来研究可以集中在最有可能接受该药物的患者身上。
