Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.

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

United States

2016-03-01T14:39:59Z

2016-01-12

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.

http://www.ncbi.nlm.nih.gov/pubmed/26674335

WNL.0000000000002266

1526-632X

https://hdl.handle.net/10161/11671

eng

Ovid Technologies (Wolters Kluwer Health)

Neurology

10.1212/WNL.0000000000002266

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

Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.

Journal article

James, Michael L|0000-0002-8715-5210

http://www.ncbi.nlm.nih.gov/pubmed/26674335

126

133

2

Anesthesiology

Anesthesiology, Neuroanesthesia

Clinical Science Departments

Duke

Neurology

Neurology, Neurocritical Care

School of Medicine

Published

86