{
  "resourceType": "Evidence",
  "id": "example-ASTRAL-12-alteplase-mRS3-6",
  "text": {
    "status": "generated",
    "div": "\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003e\n      \n      \u003cp\u003e\n        \u0026quot;Risk of mRS3-6 at 90 days after Alteplase for Stroke if ASTRAL score 12\u0026quot; is a univariate risk estimate (non-comparative evidence).\n      \u003c/p\u003e\n\t\n    \u003c/div\u003e"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "cds"
    }
  ],
  "url": "http://hl7.org/fhir/Evidence/example-ASTRAL-12-alteplase-mRS3-6",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.10.2"
    }
  ],
  "name": "RiskOfMRS36At90DaysAfterAlteplaseForStrokeIfASTRALScore12",
  "title": "Risk of mRS3-6 at 90 days after Alteplase for Stroke if ASTRAL score 12",
  "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": "External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke. \u003cb\u003eCitation:\u003c/b\u003e Cooray C, Mazya M, Bottai M, Dorado L, Skoda O, Toni D, Ford GA, Wahlgren N, Ahmed N. External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke. Stroke. 2016 Jun;47(6):1493-9. Epub 2016 May 12. PMID 27174528 \u003cb\u003eURL:\u003c/b\u003e https://doi.org/10.1161/STROKEAHA.116.012802"
    }
  ],
  "description": "5.3% risk of mRS 3-6 at 90 days",
  "variableDefinition": [
    {
      "variableRole": "population",
      "observed": {
        "reference": "Group/ASTRAL-Cooray-validation-cohort-and-received-alteplase",
        "type": "Group",
        "display": "ASTRAL validation cohort and received alteplase"
      },
      "intended": {
        "reference": "Group/ASTRAL-12-and-received-alteplase",
        "type": "Group",
        "display": "patients 0-4.5 hours after acute ischemic stroke onset with ASTRAL score \u003d 12 and received alteplase"
      }
    },
    {
      "description": "functionally dependent or dead at 3 months",
      "variableRole": "outcome",
      "observed": {
        "reference": "EvidenceVariable/example-mRS3-6-at-90days",
        "type": "EvidenceVariable",
        "display": "mRS 3-6 at 90 days"
      },
      "intended": {
        "reference": "EvidenceVariable/example-dead-or-dependent-90day",
        "type": "EvidenceVariable",
        "display": "Dead or functionally dependent at 90 days"
      },
      "directnessMatch": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/directness",
            "code": "high",
            "display": "High quality match between observed and intended variable"
          }
        ]
      }
    }
  ],
  "studyDesign": [
    {
      "coding": [
        {
          "system": "https://fevir.net/sevco",
          "code": "SEVCO:01016",
          "display": "Uncontrolled cohort design"
        }
      ]
    }
  ],
  "statistic": [
    {
      "description": "5.3% risk",
      "statisticType": {
        "coding": [
          {
            "system": "https://fevir.net/sevco",
            "code": "STATO:0000607",
            "display": "proportion"
          }
        ],
        "text": "derived proportion"
      },
      "quantity": {
        "value": 0.0525
      },
      "sampleSize": {
        "note": [
          {
            "text": "number of participants describes number in the total study sample, known data count describes number in study sample with ASTRALscore \u003d 12, total number of events describes number of participants with ASTRAL score \u003d 12 and outcome of mRS 3-6 at 90 days"
          }
        ],
        "numberOfParticipants": 36131
      }
    }
  ],
  "certainty": [
    {
      "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": "high",
            "display": "High quality"
          }
        ]
      },
      "subcomponent": [
        {
          "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": "no-concern",
                "display": "no serious concern"
              }
            ]
          }
        },
        {
          "description": "Estimated risk from validation calibration plot consistent with predicted risk; observed risk in subgroup with ASTRAL score \u003d 12 consistent with validation calibration plot",
          "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": "no-concern",
                "display": "no serious concern"
              }
            ]
          }
        },
        {
          "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": "no-concern",
                "display": "no serious concern"
              }
            ]
          }
        },
        {
          "description": "Narrow confidence interval",
          "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": "no-concern",
                "display": "no serious concern"
              }
            ]
          }
        },
        {
          "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"
              }
            ]
          }
        }
      ]
    }
  ]
}