There were elements of this story that may have confused readers, but the money quotes from an independent expert helped clarify the take-home message:
“It is also unclear how optimal medical management [lifestyle changes in addition to anti-platelet medication and statins] would affect overall stroke and cardiovascular risk, and stroke-free survival,” he said.
Understanding that the actions taken on the basis of test results can have both harms and benefits is key to being able to make an informed decision about the true value of the test to the individual.
The story included no discussion of costs. How much would these methods cost?
The story got the “gist” correct that surgery’s benefit increases with increasing risk. One of the saving graces of the piece was this independent perspective:
“It is also unclear how optimal medical management [lifestyle changes in addition to anti-platelet medication and statins] would affect overall stroke and cardiovascular risk, and stroke-free survival,” he said.
The story reported that 10 individuals in the study of 435 had TIAs. While transient ischemic attacks is one outcome of interest, the study presented the number of study participants that had strokes, and died of either stroke or cardiovascular death.
The story reported the likelihood that individuals with one or another of the problems visualized with ultrasound would have a stroke – but did not report the absolute increase in stroke that was actually observed. This information is essential for understanding the magnitude of benefit possible. And although the story included quotes from clinicians indicating that the risk of stroke is higher with carotid endarterectomy, there should have been some number provided to enable readers to understand the risks associated with the intervention that might result from having undergone the tests.
The story explained that the study followed 435 individuals who are known to have carotid stenosis and then followed them to see how well the two ultrasound measurements predicted those that would go on to have a stroke.
The story could have done a more complete job of explaining early on in the piece that the people studied were all 70 years of age or older, and all had known carotid stenosis. The results of this study are not generalizable to others who do not have this condition meaning that the tests should not be used for identifying those individuals with carotid plaques.
Quotes from two individuals who were not involved in the study reported on were included in this story.
Sorting throught the quotes from experts, it would seem that the combination of ultrasound tests could be used to better predict those individuals at lower risk who would be best off managed with medical therapy; and to better predict which individuals stand to benefit the most from surgery because their risk was higher.
The story is based on what was found with “two ultrasound methods.” But it never clarified whether there was something extraordinary about these methods and, if so, how well known are they? How widespread? How available?
It is really not clear from this story whether the 2 ultrasound techniques are new, are currently in use for other applications, are both in use for visualizing carotids but are not usually used in combination as in the study. Is this something new or not?
This story did not appear to rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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