Providing the ECST risk score increased clinician preference for carotid endarterectomy in high-risk scenarios (80.1% vs 66.7%, P=0.009) and best medical therapy in low-risk scenarios (P<0.001).
Cross-Sectional (n=201)
Does the addition of the ECST risk score influence clinician decision-making regarding carotid endarterectomy versus best medical therapy in patients with symptomatic moderate carotid atherosclerosis?
The provision of the ECST risk score significantly influences clinician decision-making, appropriately directing preference towards carotid endarterectomy in high-risk patients and best medical therapy in low-risk patients.
Absolute Event Rate: 80.1% vs 66.7%
p-value: p=0.009
BACKGROUND: Benefit from carotid endarterectomy (CEA) in symptomatic moderate (50-69 per cent) carotid stenosis remains marginal. The Fourth National Clinical Guideline for Stroke recommends use of the risk score from the European Carotid Surgery Trial (ECST) to aid decision-making in symptomatic carotid disease. It is not known whether clinicians are, in fact, influenced by it. METHODS: Using the ECST risk prediction model, three scenarios of patients with a low (less than 10 per cent), moderate (20-25 per cent) and high (40-45 per cent) 5-year risk of stroke were devised and validated. Invitations to complete an online survey were sent by e-mail to vascular surgeons and stroke physicians, with responses gathered. The questionnaire was then repeated with the addition of the ECST risk score. RESULTS: Two hundred and one completed surveys were analysed (21·5 per cent response rate): 107 by stroke physicians and 94 by vascular surgeons. The high-risk scenario after the introduction of the ECST risk score showed an increased use of CEA (66·7 versus 80·1 per cent; P = 0·009). The low-risk scenario after risk score analysis demonstrated a swing towards best medical therapy (23·4 versus 57·2 per cent; P < 0·001). CEA was preferred in the moderate-risk scenario and this was not altered significantly by introduction of the risk score (71·6 versus 75·6 per cent; P = 0·609). Vascular surgeons exhibited a preference towards CEA compared with stroke physicians in both low- and moderate-risk scenarios (P < 0·001 and P = 0·003 respectively). CONCLUSION: The addition of a risk score appeared to influence clinicians in their decision-making towards CEA in high-risk patients and towards best medical therapy in low-risk patients.
Dharmarajah et al. (Wed,) conducted a cross-sectional in Symptomatic moderate carotid atherosclerosis (n=201). Addition of the ECST risk score vs. Clinical scenarios without the ECST risk score was evaluated on Preference for carotid endarterectomy (CEA) in a high-risk patient scenario (p=0.009). Providing the ECST risk score increased clinician preference for carotid endarterectomy in high-risk scenarios (80.1% vs 66.7%, P=0.009) and best medical therapy in low-risk scenarios (P<0.001).