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JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes.

Publication ,  Journal Article
Saposnik, G; Cote, R; Mamdani, M; Raptis, S; Thorpe, KE; Fang, J; Redelmeier, DA; Goldstein, LB
Published in: Neurology
July 30, 2013

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 = 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 = 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 = 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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Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

July 30, 2013

Volume

81

Issue

5

Start / End Page

448 / 455

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Reproducibility of Results
  • Registries
  • Predictive Value of Tests
  • Physicians
  • Neurology & Neurosurgery
  • Middle Aged
 

Citation

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Saposnik, G., Cote, R., Mamdani, M., Raptis, S., Thorpe, K. E., Fang, J., … Goldstein, L. B. (2013). JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes. Neurology, 81(5), 448–455. https://doi.org/10.1212/WNL.0b013e31829d874e
Saposnik, Gustavo, Robert Cote, Muhammad Mamdani, Stavroula Raptis, Kevin E. Thorpe, Jiming Fang, Donald A. Redelmeier, and Larry B. Goldstein. “JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes.Neurology 81, no. 5 (July 30, 2013): 448–55. https://doi.org/10.1212/WNL.0b013e31829d874e.
Saposnik G, Cote R, Mamdani M, Raptis S, Thorpe KE, Fang J, et al. JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes. Neurology. 2013 Jul 30;81(5):448–55.
Saposnik, Gustavo, et al. “JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes.Neurology, vol. 81, no. 5, July 2013, pp. 448–55. Pubmed, doi:10.1212/WNL.0b013e31829d874e.
Saposnik G, Cote R, Mamdani M, Raptis S, Thorpe KE, Fang J, Redelmeier DA, Goldstein LB. JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes. Neurology. 2013 Jul 30;81(5):448–455.

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

July 30, 2013

Volume

81

Issue

5

Start / End Page

448 / 455

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Reproducibility of Results
  • Registries
  • Predictive Value of Tests
  • Physicians
  • Neurology & Neurosurgery
  • Middle Aged