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Tokunboh I, Sung EM, Chatfield F, Gaines N, Nour M, Starkman S, Saver JL. Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials. Front Neurol 2022; 13:875350. [PMID: 35645952 PMCID: PMC9136165 DOI: 10.3389/fneur.2022.875350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe modified Rankin Scale (mRS) is the most common endpoint in acute stroke trials, but its power is limited when analyzed dichotomously and its indication of effect size is challenging to interpret when analyzed ordinally. To address these issues, the utility-weighted-mRS (UW-mRS) has been developed as a patient-centered, linear scale. However, appropriate data visualizations of UW-mRS results are needed, as current stacked bar chart displays do not convey crucial utility-weighting information.Design/MethodsTwo UW-mRS display formats were devised: (1) Utility Staircase charts, and (2) choropleth-stacked-bar-charts (CSBCs). In Utility Staircase displays, mRS segment height reflects the utility value of each mRS level. In CSBCs, mRS segment color intensity reflects the utility of each mRS level. Utility Staircase and CSBC figures were generated for 15 randomized comparisons of acute ischemic/hemorrhagic stroke therapies, including fibrinolysis, endovascular reperfusion, blood pressure moderation, and hemicraniectomy. Display accuracy in showing utility outcomes was assessed with the Tufte-lie-factor and ease-of-use assessed by formal ratings completed by a panel of 4 neurologists and emergency physicians and one nurse-coordinator.ResultsThe Utility Staircase and CSBC displays rapidly conveyed patient-centered valuation of trial outcome distributions not available in conventional ordinal stacked bar charts. Tufte-lie-factor (LF) scores indicated “substantial distortion” of utility-valued outcomes for 93% (14/15) of conventional stacked bar charts, vs. “no distortion” for all Utility Staircase and CSBC displays. Clinician ratings on the Figural Display Questionnaire indicated that utility information encoded in row height (Utility Staircase display) was more readily assimilated than that conveyed in segment hue intensity (CSBC), both superior to conventional stacked bar charts.ConclusionsUtility Staircase displays are an efficient graphical format for conveying utility weighted–modified Rankin Scale primary endpoint results of acute stroke trials, and choropleth-stacked-bar-charts a good alternative. Both are more accurate in depicting quantitative, health-related quality of life results and preferred by clinician users for utility results visualization, compared with conventional stacked bar charts.
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Affiliation(s)
- Ivie Tokunboh
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eleanor Mina Sung
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Eleanor Mina Sung
| | - Fiona Chatfield
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nathan Gaines
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - May Nour
- Department of Neurology, Division of Interventional Neuroradiology, and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sidney Starkman
- Departments of Emergency Medicine and Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jeffrey L. Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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