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The Decision to Biopsy, Treat, or Wait in Suspected Herpes Encephalitis
Abstract
The availability of vidarabine for the therapy of suspected herpes simplex encephalitis presents a difficult decision for a physician as to whether to do brain biopsy, to treat blindly, or to withhold specific therapy in a patient. The choice is made more difficult because the physician must weigh four likelihoods simultaneously: namely, of the disease, of a life-threatening complication from biopsy, of a beneficial effect from vidarabine, and of a serious adverse effect from the drug. Using decision analysis, we have derived a series of threshold probabilities whereby the physician can select his own estimates of these likelihoods to arrive at a rational approach to management. When reasonable assessments are made of the risks of biopsy and of vidarabine therapy, brain biopsy is likely to be the optimal approach in the majority of patients suspected of having herpes simplex encephalitis.
Article and Author Information
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▸From the Department of Medicine, Division of Infectious Diseases, and the Clinical Decision-Making Group, Tufts-New England Medical Center Hospital; Boston, Massachusetts.
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Grant support: in part by grant 1P41RR01096 from the Division of Research Resources, National Institutes of Health, and grant 1P04LM03374 from the National Library of Medicine. Dr. Pauker is the recipient of Research Career Development Award 1K04GM00349 from the National Institute of General Medical Sciences.
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▸Requests for reprints should be addressed to Michael Barza, M.D.; Tufts-New England Medical Center Hospital, 171 Harrison Avenue; Boston MA 02111.
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- Received September 17, 1979.
- Accepted January 24, 1980.
