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Related Experiment Video

Updated: Feb 8, 2026

An Acupoint Catgut-embedding Therapy for Treating Obesity

An Acupoint Catgut-embedding Therapy for Treating Obesity

Published on: April 4, 2025

To Treat or Not to Treat?

Steven R Levine^1,2, Sarah Z Weingast³, Jeremy Weedon⁴

¹From the Departments of Neurology and Emergency Medicine (S.R.L.).

|July 7, 2018

Summary

This summary is machine-generated.

Physician decisions on alteplase treatment for minor stroke are complex. Four key factors like prior hemorrhage and anticoagulation use explain less than 15% of treatment variability.

Keywords:

contraindications decision making physicians probability stroke tissue plasminogen activator

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Area of Science:

Neurology
Clinical Medicine
Health Services Research

Background:

The 2015 US FDA alteplase (tPA) label update modified contraindications for stroke treatment.
Alteplase is a critical thrombolytic therapy for acute ischemic stroke.

Purpose of the Study:

To investigate clinical factors influencing alteplase treatment decisions in patients with minor stroke.
To quantify the impact of specific patient characteristics on physician treatment choices.

Main Methods:

An expert panel identified 7 key clinical factors for survey vignettes.
A fractional factorial design generated 150 unique patient vignettes.
194 US physicians (neurologists, emergency physicians) rated treatment likelihood on a 0-5 scale.
Conjoint statistical analysis evaluated the relative importance of each factor.

Main Results:

Treatment likelihood varied widely (6% to 95%) across vignettes.
National Institutes of Health Stroke Scale (NIHSS) score positively correlated with treatment probability (24% for NIHSS=1 vs. 41% for NIHSS=5).
Four factors—prior intracerebral hemorrhage (18%), recent anticoagulation (17%), NIHSS (13%), and prior ischemic stroke (10%)—accounted for 58% of the model's relative importance.

Conclusions:

Four main variables explain less than 15% of the total variance in alteplase treatment decisions for minor stroke.
High variability suggests significant complexity and potential for unmeasured factors influencing treatment.
Future research should explore additional variables, including physician-specific characteristics, to better understand treatment disparities.