This is a story about the possible use of MRI scans to help determine the onset time of stroke. It provided a clear explanation about how this can be an issue for people who awaken to find that they have had a stroke sometime while sleeping or someone who knows when their symptoms of stroke began but are able to articulate this information. The story explained that the decision about whether to treat a person who has had a stroke with the medication tPA rests on this piece of information. While discussing the results of the soon to be published story, the story indicated that these results need to be validated before the technology could be adopted for this purpose.
It was noteworthy that this story largely avoided hype, injecting caution about further research that is needed, while clearly showing what the potential impact of this research could be.
There was no discussion of costs – not for the individual and not for health planners and society. As we discussed in the “availability” criterion above, this is an important question.
The story reported that the test was 90% accurate, but it could have provided more insight to readers about what this 90% means.
This study is really just about predicting whether the stroke was in the past 3 hours or not. It would have been helpful to show the net effect size for strokes within 3 hours vs. those > 3 hours – it is not a very big absolute difference, but that is the cut-point that has been used.
It also could have included some information about how the rates of complication change when tPA is given to patients beyond this 3 (or 4.5 even) hour window.
Nonetheless, we’ll give it the benefit of the doubt on this criterion.
There was no mention of any possible harms associated this application of MRI technology. Although the harms would likely be small, the harm that may arise from incidental findings is worth noting. The more you scan – something being proposed in this study – the more you find, including things you didn’t need to find. That’s worth at least a line.
The story mentioned that the study reported on studied MRI scans from 130 patients who had had strokes to examine how well this technology could be used to determine whether the stroke had started with the previous 3 hours or not. It mentioned that the study reported that the test had 90% accuracy in making this retrospective determination.
The story mentioned a couple of limitations of the study and what the next research steps may be before deciding whether MRI really is a valuable tool to use as a diagnostic for time of stroke onset.
No disease mongering about stroke in this story.
The story included quotes from independent experts.
The story provided insight about a couple of situations in which it wasn’t possible to determine the time of stroke onset. The study reported on whether MRI could be used in these sorts of situations when the patient isn’t able to provide information about the time of stroke onset.
The story could have done a better job raising the question of availability of MRI around the US for urgent use at times like those described in the story or in the study – when there is a question about the 3 hour window. The story alluded to this but was not fully discussed in the context of availability of treatment. Do 80% of hospitals or hospital regions have MRIs ready for this use? 50%? 10%? Availability of the technology in question is a key concern – with huge cost implications.
The story was clear about the ‘novelty’ of using MRI technology in this way. The story did not hype MRI as a new technology but rather as a technology that was not commonly used for the purpose reported on. The story did include a quote from the lead study author that the current study supported results that have been published in the past.
It’s clear that the story did not rely solely or largely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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