TY - JOUR
T1 - JURaSSiC
T2 - Accuracy of clinician vs risk score prediction of ischemic stroke outcomes
AU - Saposnik, Gustavo
AU - Cote, Robert
AU - Mamdani, Muhammad
AU - Raptis, Stavroula
AU - Thorpe, Kevin E.
AU - Fang, Jiming
AU - Redelmeier, Donald A.
AU - Goldstein, Larry B.
PY - 2013/7/30
Y1 - 2013/7/30
N2 - Objective: We compared the accuracy of clinicians and a risk score (iScore) to predict observed outcomes following an acute ischemic stroke. Methods: The JURaSSiC (Clinician JUdgment vs Risk Score to predict Stroke outComes) study assigned 111 clinicians with expertise in acute stroke care to predict the probability of outcomes of 5 ischemic stroke case scenarios. Cases (n 5 1,415) were selected as being representative of the 10 most common clinical presentations from a pool of more than 12,000 stroke patients admitted to 12 stroke centers. The primary outcome was prediction of death or disability (modified Rankin Scale [mRS] 3) at discharge within the 95% confidence interval (CI) of observed outcomes. Secondary outcomes included 30-day mortality and death or institutionalization at discharge. Results: Clinicians made 1,661 predictions with overall accuracy of 16.9% for death or disability at discharge, 46.9% for 30-day mortality, and 33.1% for death or institutionalization at discharge. In contrast, 90%of the iScore-based estimates were within the 95%CI of observed outcomes. Nearly half (n 5 53 of 111; 48%) of participants were unable to accurately predict the probability of the primary outcome in any of the 5 rated cases. Less than 1% (n 5 1) provided accurate predictions in 4 of the 5 cases and none accurately predicted all 5 case outcomes. In multivariable analyses, the presence of patient characteristics associated with poor outcomes (mRS 3 or death) in previous studies (older age, high NIH Stroke Scale score, and nonlacunar subtype) were associated with more accurate clinician predictions of death at 30 days (odds ratio [OR] 2.40, 95% CI 1.57-3.67) and with a trend for more accurate predictions of death or disability at discharge (OR 1.85, 95% CI 0.99-3.46). Conclusions: Clinicians with expertise in stroke performed poorly compared to a validated tool in predicting the outcomes of patients with an acute ischemic stroke. Use of the risk stroke outcome tool may be superior for decision-making following an acute ischemic stroke.
AB - Objective: We compared the accuracy of clinicians and a risk score (iScore) to predict observed outcomes following an acute ischemic stroke. Methods: The JURaSSiC (Clinician JUdgment vs Risk Score to predict Stroke outComes) study assigned 111 clinicians with expertise in acute stroke care to predict the probability of outcomes of 5 ischemic stroke case scenarios. Cases (n 5 1,415) were selected as being representative of the 10 most common clinical presentations from a pool of more than 12,000 stroke patients admitted to 12 stroke centers. The primary outcome was prediction of death or disability (modified Rankin Scale [mRS] 3) at discharge within the 95% confidence interval (CI) of observed outcomes. Secondary outcomes included 30-day mortality and death or institutionalization at discharge. Results: Clinicians made 1,661 predictions with overall accuracy of 16.9% for death or disability at discharge, 46.9% for 30-day mortality, and 33.1% for death or institutionalization at discharge. In contrast, 90%of the iScore-based estimates were within the 95%CI of observed outcomes. Nearly half (n 5 53 of 111; 48%) of participants were unable to accurately predict the probability of the primary outcome in any of the 5 rated cases. Less than 1% (n 5 1) provided accurate predictions in 4 of the 5 cases and none accurately predicted all 5 case outcomes. In multivariable analyses, the presence of patient characteristics associated with poor outcomes (mRS 3 or death) in previous studies (older age, high NIH Stroke Scale score, and nonlacunar subtype) were associated with more accurate clinician predictions of death at 30 days (odds ratio [OR] 2.40, 95% CI 1.57-3.67) and with a trend for more accurate predictions of death or disability at discharge (OR 1.85, 95% CI 0.99-3.46). Conclusions: Clinicians with expertise in stroke performed poorly compared to a validated tool in predicting the outcomes of patients with an acute ischemic stroke. Use of the risk stroke outcome tool may be superior for decision-making following an acute ischemic stroke.
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UR - http://www.scopus.com/inward/citedby.url?scp=84881290238&partnerID=8YFLogxK
U2 - 10.1212/WNL.0b013e31829d874e
DO - 10.1212/WNL.0b013e31829d874e
M3 - Article
C2 - 23897872
AN - SCOPUS:84881290238
SN - 0028-3878
VL - 81
SP - 448
EP - 455
JO - Neurology
JF - Neurology
IS - 5
ER -