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

doi:10.1212/WNL.0000000000002266

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Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes

Journal article

Open access

Peer reviewed

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, …

Neurology, Vol.86(2), pp.126-133

2016-01-12

DOI: https://doi.org/10.1212/WNL.0000000000002266

PMCID: PMC4731687

PMID: 26674335

Abstract

Severity of Illness Index

Predictive Value of Tests

Risk Assessment - methods

Prognosis

Prospective Studies

Humans

Middle Aged

Male

Cerebral Hemorrhage - physiopathology

Cerebral Hemorrhage - diagnosis

Cerebral Hemorrhage - blood

Young Adult

Adolescent

Aged, 80 and over

Recovery of Function - physiology

Adult

Cerebral Hemorrhage - therapy

Female

Aged

Judgment - physiology

Physician's Role

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). 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. 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). Early subjective clinical judgment of physicians correlates more closely with 3-month outcome after ICH than prognostic scales.

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.105 Strokes; 1.105.142 Stroke
Web Of Science research areas: Clinical Neurology
ESI research areas: Neuroscience & Behavior

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Title: Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes
Creators: David Y Hwang - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.). david.hwang@yale.edu
Cameron A Dell - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Mary J Sparks - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Tiffany D Watson - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Carl D Langefeld - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Mary E Comeau - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Jonathan Rosand - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Thomas W K Battey - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Sebastian Koch - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Mario L Perez - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Michael L James - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Jessica McFarlin - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Jennifer L Osborne - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Daniel Woo - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Steven J Kittner - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Kevin N Sheth - From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
Publication Details: Neurology, Vol.86(2), pp.126-133
Publisher: United States
Grant note: R01NS059727 / NINDS NIH HHS U01NS069763 / NINDS NIH HHS
Academic Unit: Miller School of Medicine; UMMG Department of Neurology; UMMG Dept of Neurology - Stroke Div
Language: English
Resource Type: Journal article
PMID: 26674335
PMCID: PMC4731687
Record Identifier: 991031576054402976