Clinical ReasoningThis is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
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| Clinical Decision Support Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: No defined compartments |
Raw JSON (canonical form + also see JSON Format Specification)
Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior
{
"resourceType" : "Evidence",
"id" : "example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n \n <p>\n "Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior" is a comparative effect estimate.\n </p>\n\t\n </div>"
},
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "cds"
}],
"url" : "http://hl7.org/fhir/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2",
"identifier" : [{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.4.642.10.3"
}],
"name" : "EffectOfAlteplaseVsNoAlteplaseOnMRS02At90DaysInStroke345HoursPrior",
"title" : "Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior",
"status" : "draft",
"publisher" : "HL7 International / Clinical Decision Support",
"contact" : [{
"telecom" : [{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/dss"
}]
}],
"relatesTo" : [{
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/artifact-relationship-type",
"code" : "cites",
"display" : "Cites"
}]
},
"targetMarkdown" : "Figure 2 Lees 2016 <b>Citation:</b> Lees KR, Emberson J, Blackwell L, Bluhmki E, Davis SM, Donnan GA, et al; Stroke Thrombolysis Trialists’ Collaborators Group. Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials. Stroke. 2016;47:2373-2379. PMID 27507856 <b>URL:</b> https://doi.org/10.1161/STROKEAHA.116.013644"
}],
"description" : "mRS 0-2 at 90 days Odds Ratio 1.2 for Alteplase vs. No Alteplase in patients with acute ischemic stroke 3-4.5 hours prior",
"variableDefinition" : [{
"variableRole" : "population",
"observed" : {
"reference" : "EvidenceVariable/Stroke-Thrombolysis-Trialists-2014-2016-IPD-MA-Cohort",
"type" : "EvidenceVariable",
"display" : "Stroke Thrombolysis Trialists’ 2014-2016 IPD-MA Cohort"
},
"intended" : {
"reference" : "Group/AcuteIschemicStroke3-4halfHours",
"type" : "Group",
"display" : "stroke at 3-4.5 hours"
},
"directnessMatch" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/directness",
"code" : "moderate",
"display" : "Moderate quality match between observed and intended variable"
}]
}
},
{
"variableRole" : "outcome",
"observed" : {
"reference" : "EvidenceVariable/example-mRS0-2-at-90days",
"type" : "EvidenceVariable",
"display" : "mRS 0-2 at 90 days"
},
"intended" : {
"reference" : "EvidenceVariable/example-alive-independent-90day",
"type" : "EvidenceVariable",
"display" : "Alive and not functionally dependent at 90 days"
}
},
{
"variableRole" : "exposure",
"comparatorCategory" : "No Alteplase",
"observed" : {
"reference" : "EvidenceVariable/example-group-assignment-alteplase-for-stroke-vs-no-alteplase",
"type" : "EvidenceVariable",
"display" : "Group Assignment: Alteplase for Stroke vs No Alteplase"
}
}],
"synthesisType" : [{
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/synthesis-type",
"code" : "IPD-MA",
"display" : "individual patient data meta-analysis"
}]
}],
"studyDesign" : [{
"coding" : [{
"system" : "http://hl7.org/fhir/study-design",
"code" : "SEVCO:01003",
"display" : "randomized assignment"
}]
}],
"statistic" : [{
"statisticType" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/statistic-type",
"code" : "C16932",
"display" : "Odds Ratio"
}]
},
"quantity" : {
"value" : 1.2
},
"sampleSize" : {
"numberOfStudies" : 9
},
"attributeEstimate" : [{
"description" : "95% CI 1.06 to 1.3",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/attribute-estimate-type",
"code" : "C53324",
"display" : "Confidence interval"
}]
},
"level" : 0.95,
"range" : {
"low" : {
"value" : 1.06
},
"high" : {
"value" : 1.3
}
}
}]
}],
"certainty" : [{
"description" : "Very low certainty due to risk of bias, inconsistency, imprecision, and indirectness",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "Overall",
"display" : "Overall certainty"
}]
},
"rating" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "very-low",
"display" : "Very low quality"
}]
},
"subcomponent" : [{
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "PublicationBias",
"display" : "Publication bias"
}]
},
"rating" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "no-concern",
"display" : "no serious concern"
}]
}
},
{
"note" : [{
"text" : "IST-3 had inconsistent results and contributed large proportion of data"
}],
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "Inconsistency",
"display" : "Inconsistency"
}]
},
"rating" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "serious-concern",
"display" : "serious concern"
}]
}
},
{
"note" : [{
"text" : "results derived from figure with limited data reported to support the specific effect estimate; derived odds ratio in figure does not match results from rates of mRS 0-2 reported in Supplementary Figure 3b"
}],
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "Imprecision",
"display" : "Imprecision"
}]
},
"rating" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "serious-concern",
"display" : "serious concern"
}]
}
},
{
"note" : [{
"text" : "resuts derived for 3 - 4.5 hours assume data from 0 - 6 hours is informative"
}],
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "Indirectness",
"display" : "Indirectness"
}]
},
"rating" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "serious-concern",
"display" : "serious concern"
}]
}
},
{
"note" : [{
"text" : "results largely influenced by IST-3 trial which was unblinded and ECASS III which had baseline imbalances"
}],
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "RiskOfBias",
"display" : "Risk of bias"
}]
},
"rating" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "serious-concern",
"display" : "serious concern"
}]
}
}]
}]
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot3 generated on Fri, Oct 24, 2025 06:10+0000.
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