Good point about IST-3 comprising most of the Emberson cohort. The selective citation issue is real in stroke literature, tbh. One thing that gets glossed over is the time window interaction with NIHSS severity. When you're looking at minor stroke presenting early (say, sub 3 hours), the natural history is already pretty good. So even if thrombolysis does something, the absolute benefit shrinks fast. The "disabling" vs "non-disabling" distinction becomes this weird escape hatch that lets everyone keep doing what they were already doing. I worked a stroke service for abit and the definition changed based on who was on call.
Ah, well, I'm sure I can be incriminated by selective citation as well – one could argue I've discarded all manner of observational evidence regarding the ongoing "disability" of patients with "minor stroke" (as you say, the definitions are amorphous).
The real key is, at least in the U.S., this is all sort of hand-waving – no one wants to be on the hook for a lawsuit if a seemingly "non-disabling" stroke ultimately results in long-term annoyance. Add that to the bias towards action and the idea IVT is harmless in stroke mimics, and the IVT will flow ....
Good point about IST-3 comprising most of the Emberson cohort. The selective citation issue is real in stroke literature, tbh. One thing that gets glossed over is the time window interaction with NIHSS severity. When you're looking at minor stroke presenting early (say, sub 3 hours), the natural history is already pretty good. So even if thrombolysis does something, the absolute benefit shrinks fast. The "disabling" vs "non-disabling" distinction becomes this weird escape hatch that lets everyone keep doing what they were already doing. I worked a stroke service for abit and the definition changed based on who was on call.
Ah, well, I'm sure I can be incriminated by selective citation as well – one could argue I've discarded all manner of observational evidence regarding the ongoing "disability" of patients with "minor stroke" (as you say, the definitions are amorphous).
The real key is, at least in the U.S., this is all sort of hand-waving – no one wants to be on the hook for a lawsuit if a seemingly "non-disabling" stroke ultimately results in long-term annoyance. Add that to the bias towards action and the idea IVT is harmless in stroke mimics, and the IVT will flow ....