Tokunboh Ivie, Sung Eleanor Mina, Chatfield Fiona, Gaines Nathan, Nour May, Starkman Sidney, Saver Jeffrey L
Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.
Front Neurol. 2022 May 13;13:875350. doi: 10.3389/fneur.2022.875350. eCollection 2022.
The modified Rankin Scale (mRS) is the most common endpoint in acute stroke trials, but its power is limited when analyzed dichotomously and its indication of effect size is challenging to interpret when analyzed ordinally. To address these issues, the utility-weighted-mRS (UW-mRS) has been developed as a patient-centered, linear scale. However, appropriate data visualizations of UW-mRS results are needed, as current stacked bar chart displays do not convey crucial utility-weighting information.
DESIGN/METHODS: Two UW-mRS display formats were devised: (1) Utility Staircase charts, and (2) choropleth-stacked-bar-charts (CSBCs). In Utility Staircase displays, mRS segment height reflects the utility value of each mRS level. In CSBCs, mRS segment color intensity reflects the utility of each mRS level. Utility Staircase and CSBC figures were generated for 15 randomized comparisons of acute ischemic/hemorrhagic stroke therapies, including fibrinolysis, endovascular reperfusion, blood pressure moderation, and hemicraniectomy. Display accuracy in showing utility outcomes was assessed with the Tufte-lie-factor and ease-of-use assessed by formal ratings completed by a panel of 4 neurologists and emergency physicians and one nurse-coordinator.
The Utility Staircase and CSBC displays rapidly conveyed patient-centered valuation of trial outcome distributions not available in conventional ordinal stacked bar charts. Tufte-lie-factor (LF) scores indicated "substantial distortion" of utility-valued outcomes for 93% (14/15) of conventional stacked bar charts, vs. "no distortion" for all Utility Staircase and CSBC displays. Clinician ratings on the Figural Display Questionnaire indicated that utility information encoded in row height (Utility Staircase display) was more readily assimilated than that conveyed in segment hue intensity (CSBC), both superior to conventional stacked bar charts.
Utility Staircase displays are an efficient graphical format for conveying utility weighted-modified Rankin Scale primary endpoint results of acute stroke trials, and choropleth-stacked-bar-charts a good alternative. Both are more accurate in depicting quantitative, health-related quality of life results and preferred by clinician users for utility results visualization, compared with conventional stacked bar charts.
改良Rankin量表（mRS）是急性中风试验中最常见的终点指标，但二分法分析时其效能有限，而序贯分析时其效应大小的指示难以解读。为解决这些问题，已开发出效用加权mRS（UW-mRS），这是一种以患者为中心的线性量表。然而，需要对UW-mRS结果进行适当的数据可视化处理，因为当前的堆积柱状图显示无法传达关键的效用加权信息。
设计/方法：设计了两种UW-mRS显示格式：（1）效用阶梯图，以及（2）分级统计图式堆积柱状图（CSBC）。在效用阶梯图显示中，mRS段的高度反映每个mRS水平的效用值。在CSBC中，mRS段的颜色强度反映每个mRS水平的效用。为15项急性缺血性/出血性中风治疗的随机对照试验生成了效用阶梯图和CSBC图，包括纤维蛋白溶解、血管内再灌注、血压调控和颅骨切除术。通过Tufte误差因子评估显示效用结果的准确性，并由4名神经科医生、急诊医生和1名护士协调员组成的小组通过正式评分评估易用性。
效用阶梯图和CSBC图快速传达了以患者为中心的试验结果分布评估，这是传统序贯堆积柱状图所没有的。Tufte误差因子（LF）得分显示，93%（14/15）的传统堆积柱状图对效用值结果存在“严重失真”，而所有效用阶梯图和CSBC图均“无失真”。临床医生对图形显示问卷的评分表明，行高编码的效用信息（效用阶梯图显示）比段色调强度传达的信息（CSBC）更容易被理解，两者均优于传统堆积柱状图。
效用阶梯图是传达急性中风试验效用加权改良Rankin量表主要终点结果的一种有效图形格式，分级统计图式堆积柱状图是一种很好的替代方式。与传统堆积柱状图相比，两者在描绘定量健康相关生活质量结果方面更准确，并且临床医生用户更倾向于用它们来进行效用结果可视化。
