title: Field Synopsis of the Role of Sex in Stroke Prediction Models.
abstract: Guidelines for stroke prevention recommend development of sex-specific stroke risk scores. Incorporating sex in Clinical Prediction Models (CPMs) may support sex-specific clinical decision making. To better understand their potential to guide sex-specific care, we conducted a field synopsis of the role of sex in stroke-related CPMs.
  
  
  
  We identified stroke-related CPMs in the Tufts Predictive Analytics and Comparative Effectiveness CPM Database, a systematic summary of cardiovascular CPMs published from January 1990 to May 2012. We report the proportion of models including the effect of sex on stroke incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 92 stroke-related CPMs, 30 (33%) contained a coefficient for sex or presented sex-stratified models. Only 12/58 (21%) CPMs predicting outcomes in patients included sex, compared to 18/30 (60%) models predicting first stroke (P<0.0001). Sex was most commonly included in models predicting stroke among a general population (69%). Female sex was consistently associated with reduced mortality after ischemic stroke (n=4) and higher risk of stroke from arrhythmias or coronary revascularization (n=5). Models predicting first stroke versus outcomes among patients with stroke (odds ratio=5.75, 95% CI 2.18-15.14, P<0.001) and those developed from larger versus smaller sample sizes (odds ratio=4.58, 95% CI 1.73-12.13, P=0.002) were significantly more likely to include sex.
  
  
  
  Sex is included in a minority of published CPMs, but more frequently in models predicting incidence of first stroke. The importance of sex-specific care may be especially well established for primary prevention.
authors.affiliation: Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA jpaulus@tuftsmedicalcenter.org.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Paulus
authors.affiliation: Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA.
authors.forename: Lana Y H
authors.initials: LY
authors.lastname: Lai
authors.affiliation: Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA.
authors.forename: Christine
authors.initials: C
authors.lastname: Lundquist
authors.affiliation: Department of Neurology, Tufts Medical Center, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Daneshmand
authors.affiliation: Tufts University School of Medicine, Boston, MA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Buettner
authors.affiliation: Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lutz
authors.affiliation: Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA.
authors.forename: Gowri
authors.initials: G
authors.lastname: Raman
authors.affiliation: Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA Division of Cardiology, Tufts Medical Center, Boston, MA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Wessler
authors.affiliation: Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA.
authors.forename: David M
authors.initials: DM
authors.lastname: Kent
mesh_terms: D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment; D018401:Sample Size; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*
keywords: prevention; prognosis; risk factor; risk model; sex; stroke