背景:临床评分常用于卒中的诊断和治疗。虽然医学计算器是临床决策越来越重要的支持工具,对中风的普通医学计算器的摄取和使用仍然缺乏描述。
目的:我们旨在从基于网络的支持系统中描述经常使用的卒中相关医学计算器在临床决策中的使用模式。
方法:我们对MDCalc的计算器进行了回顾性研究,基于Web和基于移动应用程序的医疗计算器平台,位于美国。我们分析了来自MDCalc计算器的元数据标签,使用数据来识别与中风相关的所有计算器。使用相对页面视图作为计算器使用的度量,我们确定了2016年1月至2018年12月最常用的5种卒中相关计算器.对于所有5个计算器,我们确定了累积和季度使用,访问模式(例如,应用程序或Web浏览器),以及美国和国际使用分布。我们将2016-2018年期间的累计使用量与2011年1月至2015年12月的使用量进行了比较。
结果:在研究期间,我们确定了454个MDCalc计算器,其中48人(10.6%)与卒中相关。其中,最常用的5种计算器是房颤卒中风险计算器的CHA2DS2-VASc评分(占总数的5.5%和与卒中相关的页面访问量的32%),平均动脉压计算器(占总数的2.4%和与中风相关的页面访问量的14.0%),大出血风险的HAS-BLED评分(占总数的1.9%和与中风相关的页面浏览量的11.4%),美国国立卫生研究院卒中量表(NIHSS)评分计算器(占总数的1.7%和与卒中相关的页面浏览量的10.1%),和心房颤动卒中风险计算器的CHADS2评分(占总数的1.4%和卒中相关页面浏览量的8.1%).Web浏览器是最常见的访问方式,占个人中风计算器页面浏览量的82.7%-91.2%。访问最频繁地起源于美国境内人口最多的地区。国际上,使用大多起源于英语国家。NIHSS评分计算器显示,在研究期间的第一季度和最后一个季度之间,页面访问量的增长最大(增长238.1%)。
结论:最常用的中风计算器是CHA2DS2-VASc,平均动脉压,BLED,NIHSS,和CHADS2。这些主要是通过网络浏览器访问的,来自英语国家,来自人口稠密的地区。进一步的研究应研究中风计算器采用的障碍以及计算器使用对脑血管疾病最佳实践应用的影响。
BACKGROUND: Clinical scores are frequently used in the diagnosis and management of stroke. While medical calculators are increasingly important support tools for clinical decisions, the uptake and use of common medical calculators for stroke remain poorly characterized.
OBJECTIVE: We aimed to describe use patterns in frequently used stroke-related medical calculators for clinical decisions from a web-based support system.
METHODS: We conducted a retrospective study of calculators from MDCalc, a web-based and mobile app-based medical calculator platform based in the United States. We analyzed metadata tags from MDCalc\'s calculator use data to identify all calculators related to stroke. Using relative page views as a measure of calculator use, we determined the 5 most frequently used stroke-related calculators between January 2016 and December 2018. For all 5 calculators, we determined cumulative and quarterly use, mode of access (eg, app or web browser), and both US and international distributions of use. We compared cumulative use in the 2016-2018 period with use from January 2011 to December 2015.
RESULTS: Over the study period, we identified 454 MDCalc calculators, of which 48 (10.6%) were related to stroke. Of these, the 5 most frequently used calculators were the CHA2DS2-VASc score for atrial fibrillation stroke risk calculator (5.5% of total and 32% of stroke-related page views), the Mean Arterial Pressure calculator (2.4% of total and 14.0% of stroke-related page views), the HAS-BLED score for major bleeding risk (1.9% of total and 11.4% of stroke-related page views), the National Institutes of Health Stroke Scale (NIHSS) score calculator (1.7% of total and 10.1% of stroke-related page views), and the CHADS2 score for atrial fibrillation stroke risk calculator (1.4% of total and 8.1% of stroke-related page views). Web browser was the most common mode of access, accounting for 82.7%-91.2% of individual stroke calculator page views. Access originated most frequently from the most populated regions within the United States. Internationally, use originated mostly from English-language countries. The NIHSS score calculator demonstrated the greatest increase in page views (238.1% increase) between the first and last quarters of the study period.
CONCLUSIONS: The most frequently used stroke calculators were the CHA2DS2-VASc, Mean Arterial Pressure, HAS-BLED, NIHSS, and CHADS2. These were mainly accessed by web browser, from English-speaking countries, and from highly populated areas. Further studies should investigate barriers to stroke calculator adoption and the effect of calculator use on the application of best practices in cerebrovascular disease.