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 journalArticle

32 Citations (Scopus)

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

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Cerebral Hemorrhage
Physicians
Nursing
Patient Admission
Nonparametric Statistics
Tertiary Care Centers
Nervous System
Observational Studies
Nurses
Prospective Studies

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Hwang, D. Y., Dell, C. A., Sparks, M. J., Watson, T. D., Langefeld, C. D., Comeau, M. E., ... Sheth, K. N. (2016). Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology, 86(2), 126-133. https://doi.org/10.1212/WNL.0000000000002266

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 W K; Koch, Sebastian; Perez, Mario L.; James, Michael L.; McFarlin, Jessica; Osborne, Jennifer L.; Woo, Daniel; Kittner, Steven J.; Sheth, Kevin N.

In: Neurology, Vol. 86, No. 2, 12.01.2016, p. 126-133.

Research output: Contribution to journalArticle

Hwang, DY, Dell, CA, Sparks, MJ, Watson, TD, Langefeld, CD, Comeau, ME, Rosand, J, Battey, TWK, Koch, S, Perez, ML, James, ML, McFarlin, J, Osborne, JL, Woo, D, Kittner, SJ & Sheth, KN 2016, 'Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes', Neurology, vol. 86, no. 2, pp. 126-133. https://doi.org/10.1212/WNL.0000000000002266
Hwang DY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME et al. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology. 2016 Jan 12;86(2):126-133. https://doi.org/10.1212/WNL.0000000000002266
Hwang, David Y. ; Dell, Cameron A. ; Sparks, Mary J. ; Watson, Tiffany D. ; Langefeld, Carl D. ; Comeau, Mary E. ; Rosand, Jonathan ; Battey, Thomas W K ; Koch, Sebastian ; Perez, Mario L. ; James, Michael L. ; McFarlin, Jessica ; Osborne, Jennifer L. ; Woo, Daniel ; Kittner, Steven J. ; Sheth, Kevin N. / Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. In: Neurology. 2016 ; Vol. 86, No. 2. pp. 126-133.
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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.",
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AU - Hwang, David Y.

AU - Dell, Cameron A.

AU - Sparks, Mary J.

AU - Watson, Tiffany D.

AU - Langefeld, Carl D.

AU - Comeau, Mary E.

AU - Rosand, Jonathan

AU - Battey, Thomas W K

AU - Koch, Sebastian

AU - Perez, Mario L.

AU - James, Michael L.

AU - McFarlin, Jessica

AU - Osborne, Jennifer L.

AU - Woo, Daniel

AU - Kittner, Steven J.

AU - Sheth, Kevin N.

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N2 - 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.

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