Thrombolysis and thrombectomy in acute ischemic stroke: A RAND/UCLA consensus

INTRODUCTION: The treatment of acute ischemic stroke in the pediatric population involves considerable uncertainty due to the limited evidence on intravenous thrombolysis and mechanical thrombectomy. The objective was to assess the contribution of different scenario variables to the appropriateness of thrombolysis and thrombectomy in children and adolescents, as an aid to clinical decision-making. MATERIALS AND METHODS: The RAND/UCLA Appropriateness Method was applied. A multidisciplinary panel assessed theoretical clinical scenarios, differentiating two age groups: ≥30 days to 2 years, and >2 to <18 years. The scenarios were rated in two rounds, one of which was face-to-face. Multinomial logistic regression was performed to estimate the contribution of the variables, and CART analysis was used to synthesize the appropriateness criteria in the form of decision trees. RESULTS: values of 0.833 and 0.784, respectively, which allowed summarizing the criteria in the form of decision trees. CONCLUSIONS: Appropriateness criteria were established to support decision-making regarding thrombolysis and thrombectomy in pediatric ischemic stroke. Lesion location and symptom onset were the variables that contributed most to model fit, depending on the age group. These criteria may support decision-making in contexts of clinical uncertainty, although they cannot replace clinical judgment.