Abstract
Introduction:
Clinical scales for intracerebral hemorrhage (ICH), such as the ICH and FUNC Scores, utilize a limited number of variables for outcome prediction. The variables that physicians incorporate into subjective predictions of ICH outcome and how they relate to predictive accuracy are unknown.
Hypothesis:
Accurate physician predictions of functional outcome for ICH patients are more likely than inaccurate predictions to incorporate decision-making factors outside of the variables comprising the ICH and FUNC Scores.
Methods:
For each consecutive adult patient admitted with primary ICH at 5 centers, one physician on the treatment team was surveyed for a prediction of modified Rankin Scale (mRS) at 3 months. All predictions were prospectively collected within 24 hours of admission. Physicians were also asked to indicate up to 10 factors influencing their prediction. Accuracy was defined as an exact prediction of the mRS obtained for each patient at 3 months. The frequency of recurring factors listed by physicians were calculated for both the accurate and inaccurate predictions and compared using Fisher’s exact test.
Results:
We collected 38 accurate and 86 inaccurate predictions for 124 ICH patients. There was no difference between groups with regards to the proportion of respondents listing age, ICH volume, or general clinical exam on admission as factors. However, 16 (42.1%) of the accurate surveys listed the patient’s general co-morbidities as a factor in prediction, compared to 20 (23.3%) of inaccurate surveys (p = 0.05). Listing of pre-morbid functional status as a factor also trended towards a higher percentage in the accurate survey group (n = 7, 18.4%, versus n = 6, 7.0%; p = 0.11). Of note, all surveys that cited the etiology of the bleed (n = 5), the initial blood pressure (n= 4), and the presence or absence of an extraventricular drain (n = 7) as influencing factors contained either overly optimistic or pessimistic predictions.
Conclusions:
Accurate predictions of ICH outcome are more likely than inaccurate predictions to factor in general patient co-morbidities, which are not included in ICH or FUNC Score calculation.