<?xml version="1.0" encoding="UTF-8"?><Evidence xmlns="http://hl7.org/fhir">
  <id value="example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2"/>
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      <display value="test health data"/>
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  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">
      
      <p>
        "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.
      </p>
	
    </div>
  </text>
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  <url value="http://hl7.org/fhir/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2"/>
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    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.10.3"/>
  </identifier>
  <name value="EffectOfAlteplaseVsNoAlteplaseOnMRS02At90DaysInStroke345HoursPrior"/>
  <title value="Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior"/>
  <status value="draft"/>
  <publisher value="HL7 International / Clinical Decision Support"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/dss"/>
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  <relatesTo>
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        <display value="Cites"/>
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    <targetMarkdown value="Figure 2 Lees 2016 &lt;b&gt;Citation:&lt;/b&gt; 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 &lt;b&gt;URL:&lt;/b&gt; https://doi.org/10.1161/STROKEAHA.116.013644"/>
  </relatesTo>
  <description value="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 value="population"/>
    <observed>
      <reference value="EvidenceVariable/Stroke-Thrombolysis-Trialists-2014-2016-IPD-MA-Cohort"/>
      <type value="EvidenceVariable"/>
      <display value="Stroke Thrombolysis Trialists’ 2014-2016 IPD-MA Cohort"/>
    </observed>
    <intended>
      <reference value="Group/AcuteIschemicStroke3-4halfHours"/>
      <type value="Group"/>
      <display value="stroke at 3-4.5 hours"/>
    </intended>
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        <system value="http://terminology.hl7.org/CodeSystem/directness"/>
        <code value="moderate"/>
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      </coding>
    </directnessMatch>
  </variableDefinition>
  <variableDefinition>
    <variableRole value="outcome"/>
    <observed>
      <reference value="EvidenceVariable/example-mRS0-2-at-90days"/>
      <type value="EvidenceVariable"/>
      <display value="mRS 0-2 at 90 days"/>
    </observed>
    <intended>
      <reference value="EvidenceVariable/example-alive-independent-90day"/>
      <type value="EvidenceVariable"/>
      <display value="Alive and not functionally dependent at 90 days"/>
    </intended>
  </variableDefinition>
  <variableDefinition>
    <variableRole value="exposure"/>
    <comparatorCategory value="No Alteplase"/>
    <observed>
      <reference value="EvidenceVariable/example-group-assignment-alteplase-for-stroke-vs-no-alteplase"/>
      <type value="EvidenceVariable"/>
      <display value="Group Assignment: Alteplase for Stroke vs No Alteplase"/>
    </observed>
  </variableDefinition>
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    <statisticType>
      <coding>
        <system value="https://fevir.net/sevco"/>
        <code value="STATO:0000182"/>
        <display value="odds ratio"/>
      </coding>
    </statisticType>
    <quantity>
      <value value="1.2"/>
    </quantity>
    <sampleSize>
      <numberOfStudies value="9"/>
    </sampleSize>
    <attributeEstimate>
      <description value="95% CI 1.06 to 1.3"/>
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        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/attribute-estimate-type"/>
          <code value="C53324"/>
          <display value="Confidence interval"/>
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      </type>
      <level value="0.95"/>
      <range>
        <low>
          <value value="1.06"/>
        </low>
        <high>
          <value value="1.3"/>
        </high>
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    </attributeEstimate>
  </statistic>
  <certainty>
    <description value="Very low certainty due to risk of bias, inconsistency, imprecision, and indirectness"/>
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      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
        <code value="Overall"/>
        <display value="Overall certainty"/>
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      <coding>
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    </rating>
    <subcomponent>
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          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
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        <coding>
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          <code value="no-concern"/>
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    </subcomponent>
    <subcomponent>
      <note>
        <text value="IST-3 had inconsistent results and contributed large proportion of data"/>
      </note>
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        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
          <code value="Inconsistency"/>
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    </subcomponent>
    <subcomponent>
      <note>
        <text value="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"/>
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          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
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          <code value="serious-concern"/>
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    </subcomponent>
    <subcomponent>
      <note>
        <text value="resuts derived for 3 - 4.5 hours assume data from 0 - 6 hours is informative"/>
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          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
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          <code value="serious-concern"/>
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    </subcomponent>
    <subcomponent>
      <note>
        <text value="results largely influenced by IST-3 trial which was unblinded and ECASS III which had baseline imbalances"/>
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</Evidence>