Skip to main content

Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.

Publication ,  Journal Article
Hwang, DY; Dell, CA; Sparks, MJ; Watson, TD; Langefeld, CD; Comeau, ME; Rosand, J; Battey, TWK; Koch, S; Perez, ML; James, ML; McFarlin, J ...
Published in: Neurology
January 12, 2016

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

January 12, 2016

Volume

86

Issue

2

Start / End Page

126 / 133

Location

United States

Related Subject Headings

  • Young Adult
  • Severity of Illness Index
  • Risk Assessment
  • Recovery of Function
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Physician's Role
  • Neurology & Neurosurgery
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
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
Hwang, David Y., Cameron A. Dell, Mary J. Sparks, Tiffany D. Watson, Carl D. Langefeld, Mary E. Comeau, Jonathan Rosand, et al. “Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.Neurology 86, no. 2 (January 12, 2016): 126–33. 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):126–33.
Hwang, David Y., et al. “Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes.Neurology, vol. 86, no. 2, Jan. 2016, pp. 126–33. Pubmed, doi:10.1212/WNL.0000000000002266.
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. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology. 2016 Jan 12;86(2):126–133.

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

January 12, 2016

Volume

86

Issue

2

Start / End Page

126 / 133

Location

United States

Related Subject Headings

  • Young Adult
  • Severity of Illness Index
  • Risk Assessment
  • Recovery of Function
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Physician's Role
  • Neurology & Neurosurgery
  • Middle Aged