Introduction: Historically, physicians have been less likely to give intravenous tPA to patients with minor symptoms but evidence that mild stroke carries significant risk of permanent disability may be influencing practice.
Hypothesis: Important factors in minor stroke thrombolytic treatment decision making will be type of neurological deficit, patient age, and risk of complication.
Methods: We circulated an online survey to physicians treating acute stroke patients. We used the potentially all pairwise rankings of all possible alternatives (PAPRIKA) methodology via the 1,000Minds platform to calculate point values for six clinical criteria: communication, motor, and sensory deficits from index stroke as well as relevant history (non-ST-segment myocardial infarction within 3 months and genitourinary bleeding within 21 days), age, and premorbid disability. Survey participants were asked to choose between multiple pairs of clinical attributes in two thrombolysis treatment scenarios (e.g., 92 year old with mild hemiparesis versus 75 year old with mild aphasia) that adapted based on their prior responses. We report participant characteristics and mean part-worth utilities representing the relative importance of each criterion.
Results: Fifty-three participants completed our survey. Most participants were male (32/53), in practice >5 years (37/53), and were vascular neurologists (37/53). Overall (Figure), motor deficits were weighted most heavily (31.8%, SD 9.5) followed by communication (24.1%, SD 9.6) and sensory (16.6%, SD 6.4) deficits. Relevant history was the least heavily weighted of all criteria (4.5%, SD 4.2) while age (10.2%, SD 6.3) was assigned a similar weight as premorbid status (12.8%, SD 6.7).
Conclusions: In thrombolysis decision-making for patients with minor stroke, participants assigned more weight to patients’ motor and communication deficits than sensory deficits; age, premorbid status, and history did not play a major role.