Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes

David Y. Hwang, Cameron A. Dell, Mary J. Sparks, Tiffany D. Watson, Carl D. Langefeld, Mary E. Comeau, Jonathan Rosand, Thomas W.K. Battey, Sebastian Koch, Mario L. Perez, Michael L. James, Jessica McFarlin, Jennifer L. Osborne, Daniel Woo, Steven J. Kittner, Kevin N. Sheth

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

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.

Original languageEnglish
Pages (from-to)126-133
Number of pages8
JournalNeurology
Volume86
Issue number2
DOIs
StatePublished - Jan 12 2016

Bibliographical note

Funding Information:
The authors thank Christian Ramos, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, for assistance with cleaning the data. The Wake Forest School of Medicine Center for Public Health Genomics provided computational support Supported by the American Heart Association (Clinical Research Training Award 11CRP5480009 to K.N.S.) and National Institute of Neurological Disorders and Stroke (R01NS059727 to J.R. and U01NS069763 to D.W.). The sources of funding had no role in study design, data collection, analyses, interpretations, or decision to submit the article for publication. The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Funding Information:
The authors thank Christian Ramos, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, for assistance with cleaning the data. The Wake Forest School of Medicine Center for Public Health Genomics provided computational support Supported by the American Heart Association (Clinical Research Training Award 11CRP5480009 to K.N.S.) and National Institute of Neurological Disorders and Stroke (R01NS059727 to J.R. and U01NS069763 to D.W.). The sources of funding had no role in study design, data collection, analyses, interpretations, or decision to submit the article for publication. The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Publisher Copyright:
© 2015 American Academy of Neurology.

ASJC Scopus subject areas

  • Clinical Neurology

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