[What to do in a 60-year-old HIV-positive woman with a cerebral arteriovenous malformation? Decision analysis].
OBJECTIVE
To illustrate how clinical decision analysis can contribute to modern medical practice.


METHODS
Clinical decision analysis.


METHODS
Academic Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.


METHODS
Three treatment options (no treatment, neurosurgery and radiosurgery) for a 60-year-old HIV-positive woman with a once-ruptured cerebral arteriovenous malformation were compared using clinical decision analysis, with respect to the discounted quality adjusted life expectancy. Estimates of the risk of bleeding and its complications, of the efficacy and complications of treatment, and of the risk of developing AIDS and its consequences were based on the clinical literature.


RESULTS
Differences between no treatment and neurosurgery or radiosurgery amounted to 0.1 (plausible range: -0.27 to 0.84) and 0.2 (plausible range: -0.29 to 0.76) discounted quality adjusted life years, in favour of no treatment. The limited life expectancy of the patient, leading to a relatively low cumulative risk of haemorrhage, did not appear to justify the risks of treatment.


CONCLUSIONS
Clinical decision consultation may provide a rational, thorough and explicit decision procedure which takes into account the complexity of medical care.
Dippel
D W
DW
Afd. Neurologie, Academisch Ziekenhuis Rotterdam-Dijkzigt.
Avezaat
C J
CJ
van der Ende
M E
ME
Habbema
J D
JD
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000465:Algorithms; D002533:Cerebral Angiography; D003663:Decision Trees; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D008017:Life Expectancy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000209:etiology