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More Aggressive Treatment for Weekend Stroke

Rating

4 Star

More Aggressive Treatment for Weekend Stroke

Our Review Summary

This story about the clot-dissolving drug tPA emphasized the importance of getting to the hospital quickly in cases of suspected stroke. However, it didn’t add much to a press release issued by the AMA, and in some ways was less informative. The story provided no detail on costs or potential harms of tPA treatment, and didn’t do a very good job of explaining the benefits we can expect from the drug. It buried an important finding about mortality rates far down in the story, whereas the press release from the AMA included it in the second sentence. 

 

Why This Matters

Treatment with tPA can increase the likelihood of a full recovery from stroke if administered early enough. So if patients are more likely to receive tPA on the weekends than during the week, this is a potentially important finding that deserves to be explored. That being said, coverage of tPA needs to provide context regarding the significant risks and costs associated with this treatment.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not discuss the costs or potential savings associated with the use of this drug.  On the cost side, there are the direct costs of the drug itself as well as the diagnostic testing which must be conducted prior to administering the drug. In addition, hospitals incur significant costs to become certified as a primary stroke treatment centers, which is where candidates for tPA therapy are most likely to be taken by ambulance teams. On the savings side, successful treatment with tPA would potentially prevent significant expenditures on the care of disabled stroke patients.  

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story doesn’t do a good enough job explaining what they observed in the study or the benfits of tPA in general. In discussing the differences between weekday and weekend treatment, the story reports that there was a 20% difference in the likelihood of receiving tPA. In absolute terms, however, the difference between weekdays and weekends is very small (1.1% vs 0.9%). In addition, there is some discussion about why the study did not detect a reduction in deaths among patients treated on the weekend and who were more likely to receive tPA. The study could have noted that tPA has never been shown to reduce mortality in randomized clinical trials. The primary benefit of tPA—which is never explained in the story—is that it may increase the likelihood of a patient’s recovery from stroke without disability.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory
The story makes no mention of the serious risks associated with the use of tPA, which include potentially fatal bleeding in the brain. Indeed, it is because of these serious risks that hospitals require the diagnostic testing and expert neurologic consults discussed in the story. These are to make sure tPA is administered only to patients for whom the expected benefit will outweigh the risk of serious harm. 

Does the story seem to grasp the quality of the evidence?

Satisfactory
The story includes some critical analysis from an independent expert regarding shortcomings in the researcher’s methods. The expert pointed out two factors – the severity of the stroke and the time to presentation – which could have affected the results and were not accounted for in the analysis.

Does the story commit disease-mongering?

Satisfactory
The story does not exaggerate the prevalence or severity of strokes.
 

Does the story use independent sources and identify conflicts of interest?

Satisfactory
The story quotes a neurologist who is not affiliated with the study. None of the sources in the story appear to have undisclosed conflicts of interest.

Does the story compare the new approach with existing alternatives?

Not Applicable

The story was primarily about weekday vs. weekend use of tPA. While it could have mentioned other stroke treatments with proven benefits, such as aspirin, it would probably be unfair to dock points for not including this information.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story explains that the tPA is only used within 3 hours of the onset of stroke symptoms. It also hints at the fact that tPA is effective only for ischemic strokes, and that treatment is more likely to be available at certified stroke treatment centers. While it could have done more to make the limitations on tPA’s use explicit, the reader will probably come away with the sense that tPA is available only for certain patients where it can be used early. This is a satisfactory outcome.  

Does the story establish the true novelty of the approach?

Satisfactory
tPA has been approved for use since 1996, and the story specifies that the study included patients treated as far back as 1998.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Although it recites much of the same information included in an AMA press release about the study, the story includes an interview with one of the study researchers as well as with an independent expert. While this is enough for a satisfactory rating, it should be noted that the press release for this study appears to have taken a more critical view of the results than the HealthDay report. The press release stated in the first paragraph that stroke death rates were the same in this study among weekend and weekday admissions, whereas the HealthDay report took nine paragraphs to relay this information.

Total Score: 6 of 9 Satisfactory

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