Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Canada (M.G., A.G.).
Department of Radiology (M.G.), University of Calgary, Canada.
Stroke. 2021 May;52(5):1921-1928. doi: 10.1161/STROKEAHA.120.033785. Epub 2021 Mar 26.
Physicians often base their decisions to offer acute stroke therapies to patients around the question of whether the patient will benefit from treatment. This has led to a plethora of attempts at accurate outcome prediction for acute ischemic stroke treatment, which have evolved in complexity over the years. In theory, physicians could eventually use such models to make a prediction about the treatment outcome for a given patient by plugging in a combination of demographic, clinical, laboratory, and imaging variables. In this article, we highlight the importance of considering the limits and nuances of outcome prediction models and their applicability in the clinical setting. From the clinical perspective of decision-making about acute treatment, we argue that it is important to consider 4 main questions about a given prediction model: (1) what outcome is being predicted, (2) what patients contributed to the model, (3) what variables are in the model (considering their quantifiability, knowability at the time of decision-making, and modifiability), and (4) what is the intended purpose of the model? We discuss relevant aspects of these questions, accompanied by clinically relevant examples. By acknowledging the limits of outcome prediction for acute stroke therapies, we can incorporate them into our decision-making more meaningfully, critically examining their contents, outcomes, and intentions before heeding their predictions. By rigorously identifying and optimizing modifiable variables in such models, we can be empowered rather than paralyzed by them.
医生通常根据患者是否能从治疗中受益这一问题来决定是否为急性脑卒中患者提供治疗。这导致了大量对急性缺血性脑卒中治疗进行准确预后预测的尝试，这些尝试多年来在复杂性上不断发展。从理论上讲，医生最终可以通过输入一系列人口统计学、临床、实验室和影像学变量，对特定患者的治疗结果做出预测。在本文中，我们强调了考虑预后预测模型的局限性和细微差别及其在临床环境中的适用性的重要性。从急性治疗决策的临床角度来看，我们认为重要的是要考虑关于给定预测模型的 4 个主要问题：(1) 预测的结果是什么，(2) 哪些患者为模型做出了贡献，(3) 模型中的变量是什么(考虑到它们的可量化性、决策时的可知性和可修改性)，以及(4) 模型的预期用途是什么？我们讨论了这些问题的相关方面，并附有临床相关示例。通过承认急性脑卒中治疗预后预测的局限性，我们可以更有意义地将其纳入我们的决策过程，在关注其预测结果之前，批判性地检查其内容、结果和意图。通过严格识别和优化此类模型中的可修改变量，我们可以利用它们，而不是被它们所束缚。
