Clinical Neuroepidemiology

Koprowski, Christopher; Longstreth, W. T.; Cebul, Randall D.

doi:10.1001/archneur.1989.00520380129027

Cited by 9 publications

(1 citation statement)

References 37 publications

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“…The robustness of the analysis was assessed by sensitivity analysis, i.e. by testing how sensitive the optimal decision would be to changes in estimates with in the plausible range [22][23][24],…”

Section: Management Of Subarachnoid Haemorrhagementioning

confidence: 99%

Management of Subarachnoid Haemorrhage: A Decision Analysis

et al. 1995

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The management of subarachnoid haemorrhage is studied by decision analysis. Optimal treatment strategies for individual patients are identified, by combining early surgery (on day 2), delayed surgery (on day 10), late elective surgery after 3 months, antifibrinolytics and nimodipine. The risks of rebleeding, infarction and mortality from the initial haemorrhage were estimated by proportional hazards regression in a reanalysis of a randomized clinical trial of antifibrinolytics against placebo. These combined with data from the literature are used in a decision tree to compute the chances of good recovery, moderate and severe disability and death after 3 months, and the (discounted quality-adjusted) life expectancy for each treatment strategy. Treatment with nimodipine is recommended for all patients. For patients in good clinical condition at admission, antifibrinolytics and delayed surgery form the optimal treatment strategy. However, the benefits of early or delayed surgery are small compared to elective late surgery in this group, and therefore the surgical complication rate should be low. Patients with a heavy load of subarachnoid blood on CT scan should be treated with (delayed) surgery, but not with antifibrinolytics, because of the increased risk of infarction. Late elective surgery is recommended for patients with good outcome after 3 months who have not yet been operated.

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Section: Management Of Subarachnoid Haemorrhagementioning

confidence: 99%

Management of Subarachnoid Haemorrhage: A Decision Analysis

et al. 1995

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Evidence-Based Medicine in Neurology

Nelson¹,

Tanner²,

Eeden³

et al. 2004

Neuroepidemiology

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This chapter describes the principals and practice of evidence-based medicine (EBM), its limitations, and future directions for EBM. The goal of EBM is to provide high quality information in “real time” for neurologists to use in practice. Evidence-based medicine provides a set of tools to formulate a clinically important question about a particular patient and to efficiently access and critically evaluate relevant information. Neuroepidemiologic studies provide the groundwork for evidence-based medicine by supplying research about patient risk, prognosis, and harm.

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Decision analysis in the clinical neurosciences: a systematic review of the literature

Dippel

Habbema

1995

Euro J of Neurology

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Clinical decision analysis can be a useful scientific tool for individual patient management, for planning of clinical research and for reaching consensus about clinical problems. We systematically reviewed the decision analytic studies in the clinical neurosciences that were published between 1975 and July 1994. All studies were assessed on aspects of clinical applicability: presence of case and context description, completeness of the analysed strategies from a clinical point of view, extendibility of the analyses to different patient profiles, and up-to-date-ness. Fifty-nine decision analyses of twenty-eight different clinical problems were identified. Twenty-eight analyses were based on the theory of subjective expected utility, twelve on cost-effectiveness analysis. Four studies used ROC analysis, and fifteen were risk-, or risk-benefit analyses. At least six studies could have been improved by more elaborately disclosing the context of the clinical problem that was addressed. In eleven studies, the effect of different, yet plausible assumptions was not explored, and in eighteen studies the reader was not informed how to extend the results of the analysis to patients with (slightly) different clinical characterisitics. All studies had, by nature, the potential to promote insight into the clinical problem and focus the discussion on clinically important aspects, and gave clinically useful advice. We conclude that clinical decision analysis, as an explicit, quantitative approach to uncertainty in decision making in the clinical neurosciences will fulfill a growing need in the near future.

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Clinical Neuroepidemiology

Cited by 9 publications

References 37 publications

Management of Subarachnoid Haemorrhage: A Decision Analysis

Management of Subarachnoid Haemorrhage: A Decision Analysis

Evidence-Based Medicine in Neurology

Decision analysis in the clinical neurosciences: a systematic review of the literature

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