Table 3.

Amendments to the beta version of COMPASS following feasibility testing in the clinical setting

Amendment	Rationale
Revisions to decision analytic model	• Enhanced clinical face validity of predicted outcomes and accuracy of predicted risk of SICH
o Time horizon of three months for predicted outcomes (independence, dependence and death)
o Inclusion of new scoring model for risk of symptomatic intracranial haemorrhage, which necessitated the addition ‘current use of Clopidogrel’ and ‘history of hypertension’ to the list of patient details
Inclusion of the additional features:	• Enhanced clinical utility and interpretability
o rt-PA dosage calculator, with a pop-up icon displaying detailed dosage figures
o Glucose conversion tool (mg/dl to mmol/L)
o Line graph incorporated into timeline function to show more clearly the decrease in likely benefit from thrombolysis as a function of stroke onset time to treatment
Amendments to list of patient details and warning messages:	• Enhanced clinical face validity and usability, reduced risk of data entry errors and security with data validation
o Amended warning for entered NIHSS values < 5 and > 25: “The license states that a minor neurological deficit or severe stroke as assessed clinically (NIHSS > 25) are relative contraindications to treatment with rt-PA. For patients with mild stroke the risks may outweigh the expected benefit. Patients with very severe stroke are at increased risk of intra-cerebral haemorrhage.”
o Rules for number of integers that need to be entered for onset time, target treatment time, age, systolic blood pressure, glucose and weight); e.g. users must enter >1 and <4 integers for systolic blood pressure
o Signs of early infarction on CT/MRI scan replaced with ‘Signs of current infarction at baseline imaging’
o Larger text boxes for two patient details: systolic blood pressure and glucose (BM)
o Added flexibility for stoke onset time and target treatment time – users can enter values in multiple formats (hhmm, hh:mm, hh.mm)
Amendments to the risk presentations:	• Enhanced interpretability of predicted clinical outcomes
o Addition of time horizon for SICH ‘within 24–36 hours after clot-busting treatment’
o Added to whitespace area: “Please note: predicted clinical outcomes at 3 months apply to patients with pre-stroke modified Rankin scores of 0 to 2”
Other amendments to the user interface:	• Enhanced usability and
o Inclusion of ‘acute ischaemic stroke’ to header ‘predicted clinical outcomes’	• acceptance of the decision aid
o Disabled copy/paste function (tablet computer only)
o Inclusion of readability statistics and production date