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Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.

dc.contributor.author Battey, TW
dc.contributor.author Comeau, ME
dc.contributor.author Dell, CA
dc.contributor.author Hwang, DY
dc.contributor.author James, Michael Lucas
dc.contributor.author Kittner, SJ
dc.contributor.author Koch, S
dc.contributor.author Langefeld, CD
dc.contributor.author McFarlin, J
dc.contributor.author Osborne, JL
dc.contributor.author Perez, ML
dc.contributor.author Rosand, J
dc.contributor.author Sheth, KN
dc.contributor.author Sparks, MJ
dc.contributor.author Watson, TD
dc.contributor.author Woo, D
dc.coverage.spatial United States
dc.date.accessioned 2016-03-01T14:39:59Z
dc.date.issued 2016-01-12
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/26674335
dc.identifier WNL.0000000000002266
dc.identifier.uri http://hdl.handle.net/10161/11671
dc.description.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.
dc.language eng
dc.relation.ispartof Neurology
dc.relation.isversionof 10.1212/WNL.0000000000002266
dc.subject Adolescent
dc.subject Adult
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Cerebral Hemorrhage
dc.subject Female
dc.subject Humans
dc.subject Judgment
dc.subject Male
dc.subject Middle Aged
dc.subject Physician's Role
dc.subject Predictive Value of Tests
dc.subject Prognosis
dc.subject Prospective Studies
dc.subject Recovery of Function
dc.subject Risk Assessment
dc.subject Severity of Illness Index
dc.subject Young Adult
dc.title Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/26674335
pubs.begin-page 126
pubs.end-page 133
pubs.issue 2
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, Neuroanesthesia
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Neurology
pubs.organisational-group Neurology, Neurocritical Care
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 86
dc.identifier.eissn 1526-632X


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