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Evidence-example-ASTRAL-12-alteplase-mRS3-6.xml

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Not linked to any defined compartments

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Risk of mRS3-6 at 90 days after Alteplase for Stroke if ASTRAL score 12 (id = "example-ASTRAL-12-alteplase-mRS3-6")

<?xml version="1.0" encoding="UTF-8"?>

<Evidence xmlns="http://hl7.org/fhir">
  <id value="example-ASTRAL-12-alteplase-mRS3-6"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p> 
        &quot;Risk of mRS3-6 at 90 days after Alteplase for Stroke if ASTRAL score 12&quot;
         is a univariate risk estimate.
      </p> 
  </div> 
  </text> 
  <url value="Evidence/example-ASTRAL-12-alteplase-mRS3-6"/> 
  <title value="Risk of mRS3-6 at 90 days after Alteplase for Stroke if ASTRAL score 12"/> 
  <status value="draft"/> 
  <relatedArtifact> 
    <type value="citation"/> 
    <label value="Cooray 2016 Validation Study"/> 
    <display value="External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome
     in Stroke."/> 
    <citation value="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"/> 
    <url value="https://doi.org/10.1161/STROKEAHA.116.012802"/> 
  </relatedArtifact> 
  <description value="5.3% risk of mRS 3-6 at 90 days"/> 
  <variableDefinition> 
    <variableRole> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/> 
        <code value="population"/> 
        <display value="population"/> 
      </coding> 
    </variableRole> 
    <observed> 
      <reference value="Group/ASTRAL-Cooray-validation-cohort"/> 
      <type value="Group"/> 
      <display value="ASTRAL validation cohort"/> 
    </observed> 
    <intended> 
      <reference value="Group/ASTRAL-12"/> 
      <type value="Group"/> 
      <display value="patients 0-4.5 hours after acute ischemic stroke onset with ASTRAL score = 12"/> 
    </intended> 
  </variableDefinition> 
  <variableDefinition> 
    <description value="functionally dependent or dead at 3 months"/> 
    <variableRole> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/> 
        <code value="measuredVariable"/> 
        <display value="measured variable"/> 
      </coding> 
    </variableRole> 
    <observed> 
      <reference value="EvidenceVariable/example-mRS3-6-at-90days"/> 
      <type value="EvidenceVariable"/> 
      <display value="mRS 3-6 at 90 days"/> 
    </observed> 
    <intended> 
      <reference value="EvidenceVariable/example-dead-or-dependent-90day"/> 
      <type value="EvidenceVariable"/> 
      <display value="Dead or functionally dependent at 90 days"/> 
    </intended> 
    <directnessMatch> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/directness"/> 
        <code value="high"/> 
        <display value="High quality match"/> 
      </coding> 
    </directnessMatch> 
  </variableDefinition> 
  <variableDefinition> 
    <variableRole> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/> 
        <code value="exposure"/> 
        <display value="exposure"/> 
      </coding> 
    </variableRole> 
    <observed> 
      <reference value="EvidenceVariable/example-alteplase-for-stroke"/> 
      <type value="EvidenceVariable"/> 
      <display value="Alteplase for Stroke"/> 
    </observed> 
    <intended> 
      <reference value="EvidenceVariable/example-alteplase-for-stroke"/> 
      <type value="EvidenceVariable"/> 
      <display value="Alteplase for Stroke"/> 
    </intended> 
    <directnessMatch> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/directness"/> 
        <code value="exact"/> 
        <display value="Exact match"/> 
      </coding> 
    </directnessMatch> 
  </variableDefinition> 
  <studyType> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/study-type"/> 
      <code value="series"/> 
      <display value="uncontrolled cohort or case series"/> 
    </coding> 
  </studyType> 
  <statistic> 
    <description value="5.3% risk"/> 
    <statisticType> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/statistic-type"/> 
        <code value="C44256"/> 
        <display value="Proportion"/> 
      </coding> 
      <text value="derived proportion"/> 
    </statisticType> 
    <quantity> 
      <value value="0.0525"/> 
    </quantity> 
    <sampleSize> 
      <note> 
        <text value="number of participants describes number in the total study sample, known data count describes
         number in study sample with ASTRALscore = 12, total number of events describes number
         of participants with ASTRAL score = 12 and outcome of mRS 3-6 at 90 days"/> 
      </note> 
      <numberOfParticipants value="36131"/> 
    </sampleSize> 
  </statistic> 
  <certainty> 
    <type> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/> 
        <code value="Overall"/> 
        <display value="Overall quality"/> 
      </coding> 
    </type> 
    <rating> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
        <code value="high"/> 
        <display value="High quality"/> 
      </coding> 
    </rating> 
    <subcomponent> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/> 
          <code value="RiskOfBias"/> 
          <display value="Risk of bias"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </subcomponent> 
    <subcomponent> 
      <description value="Estimated risk from validation calibration plot consistent with predicted risk; observed
       risk in subgroup with ASTRAL score = 12 consistent with validation calibration plot"/> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/> 
          <code value="Inconsistency"/> 
          <display value="Inconsistency"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </subcomponent> 
    <subcomponent> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/> 
          <code value="Indirectness"/> 
          <display value="Indirectness"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </subcomponent> 
    <subcomponent> 
      <description value="Narrow confidence interval"/> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/> 
          <code value="Imprecision"/> 
          <display value="Imprecision"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </subcomponent> 
    <subcomponent> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/> 
          <code value="PublicationBias"/> 
          <display value="Publication bias"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </subcomponent> 
  </certainty> 
</Evidence> 

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.