Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.
Abstract
OBJECTIVE: To compare the performance of formal prognostic instruments vs subjective
clinical judgment with regards to predicting functional outcome in patients with spontaneous
intracerebral hemorrhage (ICH). METHODS: This prospective observational study enrolled
121 ICH patients hospitalized at 5 US tertiary care centers. Within 24 hours of each
patient's admission to the hospital, one physician and one nurse on each patient's
clinical team were each asked to predict the patient's modified Rankin Scale (mRS)
score at 3 months and to indicate whether he or she would recommend comfort measures.
The admission ICH score and FUNC score, 2 prognostic scales selected for their common
use in neurologic practice, were calculated for each patient. Spearman rank correlation
coefficients (r) with respect to patients' actual 3-month mRS for the physician and
nursing predictions were compared against the same correlation coefficients for the
ICH score and FUNC score. RESULTS: The absolute value of the correlation coefficient
for physician predictions with respect to actual outcome (0.75) was higher than that
of either the ICH score (0.62, p = 0.057) or the FUNC score (0.56, p = 0.01). The
nursing predictions of outcome (r = 0.72) also trended towards an accuracy advantage
over the ICH score (p = 0.09) and FUNC score (p = 0.03). In an analysis that excluded
patients for whom comfort care was recommended, the 65 available attending physician
predictions retained greater accuracy (r = 0.73) than either the ICH score (r = 0.50,
p = 0.02) or the FUNC score (r = 0.42, p = 0.004). CONCLUSIONS: Early subjective clinical
judgment of physicians correlates more closely with 3-month outcome after ICH than
prognostic scales.
Type
Journal articleSubject
AdolescentAdult
Aged
Aged, 80 and over
Cerebral Hemorrhage
Female
Humans
Judgment
Male
Middle Aged
Physician's Role
Predictive Value of Tests
Prognosis
Prospective Studies
Recovery of Function
Risk Assessment
Severity of Illness Index
Young Adult
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https://hdl.handle.net/10161/11671Published Version (Please cite this version)
10.1212/WNL.0000000000002266Publication Info
Hwang, David Y; Dell, Cameron A; Sparks, Mary J; Watson, Tiffany D; Langefeld, Carl
D; Comeau, Mary E; ... Sheth, Kevin N (2016). Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.
Neurology, 86(2). pp. 126-133. 10.1212/WNL.0000000000002266. Retrieved from https://hdl.handle.net/10161/11671.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Michael Lucas James
Associate Professor of Anesthesiology
I have an extensive background in neuroanesthesia and neurointensive care and a special
research interest in translational and clinical research aspects of intracerebral
hemorrhage.
After completing residencies in neurology and anesthesiology with fellowships in neurocritical
care, neuroanesthesia, and vascular neurology, I developed a murine model of intracerebral
hemorrhage in the Multidisciplinary Neuroprotection Laboratories at Duke University.
After optimization of the model, I h
Jessica McFarlin
Assistant Professor- Track IV of Neurology
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
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