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Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes.

Publication ,  Journal Article
Hwang, DY; Chu, SY; Dell, CA; Sparks, MJ; Watson, TD; Langefeld, CD; Comeau, ME; Rosand, J; Battey, TWK; Koch, S; Perez, ML; James, ML ...
Published in: Neurocrit Care
December 2017

BACKGROUND: The early subjective clinical judgment of clinicians outperforms formal prognostic scales for accurate determination of outcome after intracerebral hemorrhage (ICH), with the judgment of physicians and nurses having equivalent accuracy. This study assessed specific decisional factors that physicians and nurses incorporate into early predictions of functional outcome. METHODS: This prospective observational study enrolled 121 ICH patients at five US centers. Within 24 h of each patient's admission, one physician and one nurse on the clinical team were each surveyed to predict the patient's modified Rankin Scale (mRS) at 3 months and to list up to 10 subjective factors used in prognostication. Factors were coded and compared between (1) physician and nurse and (2) accurate and inaccurate surveys, with accuracy defined as an exact prediction of mRS. RESULTS: Aside from factors that are components of the ICH or FUNC scores, surveys reported pre-existing comorbidities (40.0%), other clinical or radiographic factors not in clinical scales (43.0%), and non-clinical/radiographic factors (21.9%) as important. Compared to physicians, nurses more frequently listed neurologic examination components (Glasgow Coma Scale motor, 27.3 vs. 5.8%, p < 0.0001; GCS verbal, 12.4 vs. 0.0%, p < 0.0001) and non-clinical/radiographic factors (31.4 vs. 12.4%, p = 0.0005). Physicians more frequently listed neuroimaging factors (ICH location, 33.9 vs. 7.4%, p < 0.0001; intraventricular hemorrhage, 13.2 vs. 2.5%, p = 0.003). There was no difference in listed factors between accurate versus inaccurate surveys. CONCLUSIONS: Clinicians frequently utilize factors outside of the components of clinical scales for prognostication, with physician and nurses focusing on different factors despite having similar accuracy.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

December 2017

Volume

27

Issue

3

Start / End Page

316 / 325

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Prospective Studies
  • Prognosis
  • Outcome Assessment, Health Care
  • Nursing Staff, Hospital
  • Neurology & Neurosurgery
  • Middle Aged
  • Medical Staff, Hospital
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Hwang, D. Y., Chu, S. Y., Dell, C. A., Sparks, M. J., Watson, T. D., Langefeld, C. D., … Sheth, K. N. (2017). Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes. Neurocrit Care, 27(3), 316–325. https://doi.org/10.1007/s12028-017-0430-7
Hwang, David Y., Stacy Y. Chu, Cameron A. Dell, Mary J. Sparks, Tiffany D. Watson, Carl D. Langefeld, Mary E. Comeau, et al. “Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes.Neurocrit Care 27, no. 3 (December 2017): 316–25. https://doi.org/10.1007/s12028-017-0430-7.
Hwang DY, Chu SY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, et al. Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes. Neurocrit Care. 2017 Dec;27(3):316–25.
Hwang, David Y., et al. “Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes.Neurocrit Care, vol. 27, no. 3, Dec. 2017, pp. 316–25. Pubmed, doi:10.1007/s12028-017-0430-7.
Hwang DY, Chu SY, 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. Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes. Neurocrit Care. 2017 Dec;27(3):316–325.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

December 2017

Volume

27

Issue

3

Start / End Page

316 / 325

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Prospective Studies
  • Prognosis
  • Outcome Assessment, Health Care
  • Nursing Staff, Hospital
  • Neurology & Neurosurgery
  • Middle Aged
  • Medical Staff, Hospital
  • Male
  • Humans