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Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.

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Date
2016-01-12
Authors
Hwang, David Y
Dell, Cameron A
Sparks, Mary J
Watson, Tiffany D
Langefeld, Carl D
Comeau, Mary E
Rosand, Jonathan
Battey, Thomas WK
Koch, Sebastian
Perez, Mario L
James, Michael L
McFarlin, Jessica
Osborne, Jennifer L
Woo, Daniel
Kittner, Steven J
Sheth, Kevin N
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(16 total)
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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 article
Subject
Adolescent
Adult
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
Permalink
https://hdl.handle.net/10161/11671
Published Version (Please cite this version)
10.1212/WNL.0000000000002266
Publication 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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Scholars@Duke

James

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.
Alphabetical list of authors with Scholars@Duke profiles.
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