Decision time.
Treat or not?

Thrombolysis must be given within 4.5 hours of onset of stroke symptoms.

Treatment benefit-to-risk ratio differs as a function of individual patient characteristics. Thrombolysis is no different.

COMPASS clearly communicates the benefits versus the risks of thrombolysis to patients/relatives. It augments the consent process where appropriate and engages.

A digital decision aid for stroke thrombolysis

COMPASS is a system deployed online for maximum accessibility that provides the most accurate predictive outcome assessment in the world for thrombolysis treatment.  It is device agnostic and can be used in theatre, on the ward, in the ambulance or for clinical training.

  • Screen 01Predicitve Algorithms
  • screen 02Easy to read decision trees
  • screen 03Clear description of risks
  • Clear and easy to read timeline data

In the UK 1 person suffers a stroke every five minutes.

Globally 15 million people every year have a stroke.

80% of these are ischaemic strokes.

50% all stroke sufferers depend on support from others for help with daily activities.


Thrombolysis is a critically important treatment for acute ischaemic(blocked artery) strokes that needs to be administered as soon as possible and within 4.5 hours following stroke onset.

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The importance of early treatment is encapsulated in the ‘Time is Brain’ aphorism that stroke teams work to, with stroke teams aiming to assess, obtain a brain CT scan and administer thrombolysis within 30 minutes of arrival at hospital. Thrombolysis reduces the likelihood that patients will be left with long-term disability (on average 14 out of 100 patients treated are functionally independent who would otherwise have been left disabled) but it is associated with a risk of symptomatic intracranial haemorrhage (brain bleeding that usually leads to clinical deterioration or death) in about 3 in every 100 patients treated. However, these are average figures and the balance of risks and benefits varies considerably between individual patients and this is dependent on complex computation of multiple variables to support a rapid decision on what to recommend to patients/family.

Following a systematic development process that involved stroke clinicians, stroke patients and their relatives in an iterative design process, the research team designed a COMPuterised decision Aid for Stroke thrombolySis (COMPASS).

COMPASS allows stroke clinicians to input the details of an individual stroke patient into a tablet device and formulate numerical (percentages and natural frequencies – out of 100 patients) and graphical risk presentations (coloured pictographs, bar charts or flow diagrams alongside stacked bar charts) showing the predicted likelihood of functional independence [complete recovery or minor disability], dependence [moderate to severe disability] and death at three months, with and without thrombolysis, including risk of symptomatic intracranial haemorrhage (SICH) and the impact of any SICH.

COMPASS includes the capability to save and print out copies of patient-specific predictions, which can be shared with the patient and/or family either on screen or on paper to support consent and effectively engage patients/family in decisions on whether to accept or decline thrombolysis based on evidence-based and personalised data. In addition, it includes a National Institute of Health Stroke Scale (NIHSS – used by stroke physicians to assess the severity and extent of impairments due to stroke) calculator, an onset time to treatment and thrombolysis dosage calculator, and weight (stones/lbs to Kg) and glucose conversion (mg/ dl to mmol/L) tools. In current practice these are largely undertaken using paper-based materials. COMPASS also includes a timeline graph showing the decrease in predicted net benefit from thrombolytic treatment as a function of increasing stroke onset time to treatment, which further emphasises the aphorism – time is brain! The decision aid can be used by any stroke physician, neurologist or emergency medicine specialist who is offering thrombolysis to stroke patients. The numerical/graphical presentations that are generated by COMPASS can be used by the treating stroke clinician to weigh-up patient-specific risks and benefits of treating an individual acute ischaemic stroke patient, and can also be shown to the patient or family member to support informed consent and shared decision making. COMPASS can also be used as a clinical training aid and as an adjunct to the telemedicine model of acute stroke care. COMPASS can help to optimise thrombolysis

treatment and support high quality informed consent with patients/relatives by aiding the treating clinician in communicating the ‘personalised’ benefits and risks in an easily understandable way, thus enabling patients/ relatives to be more involved in the decision
making discussion with clinicians.

COMPASS presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1241). The views expressed here are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The NIHR had no role in the design or development of COMPASS. The pharmaceutical company (Boehringer Ingelheim) is the manufacturer of thrombolysis (Alteplase), but they have had no involvement in the development of COMPASS.

COMPASS expresses predictions for acute stroke outcomes (functional independence [mRS 0 to 2], dependence [mRS 3 to 5] and death at three months), with and without thrombolysis, including risk of symptomatic intracranial haemorrhage1, as a function of individual patient characteristics derived from an embedded decision analytic model
(see figure).
1 Symptomatic intracerebral haemorrhage (SICH – bleeding in the brain) is defined in accordance with SITS-MOST: local or remote parenchymal haemorrhage type 2 on the imaging scan at 22-36 h after treatment, combined with a neurological deterioration of 4 or more points on the NIHSS from baseline, or from the lowest NIHSS score between baseline and 24 h, or leading to death

Summary of data sources / predictive equations

Thrombolysis is a critically important treatment for acute ischaemic(blocked artery) strokes that needs to be administered as soon as possible and within 4.5 hours following stroke onset.

Net benefit

COMPASS helps weigh up the NET BENEFIT of treating any individual patient with thrombolysis.  It clearly shows the benefits Vs the risks associated with treatment and helps make informed decisions.

The long hard road to recovery

14 in every 100 patients treated will completely recover or have minor disability (who would otherwise be moderately or severely disabled).

Singing together

Bleeding in the brain occurs in 3 in every 100 patients typically leading to severe disability or death have minor disability (who would otherwise be moderately or severely disabled).


Newcastle hospital
COMPASS is hosted and managed by Pro-Quol, part of the Pro-Mapp Group.