[S45.006] Subjective Judgments of Physicians and Nurses Are More Accurate Than Formal Clinical Scales in Predicting Functional Outcome After Intracerebral Hemorrhage
David Hwang,1Cameron A. Dell,2Mary J. Sparks,2Tiffany D. Watson,2Carl Langefeld,3Mary Comeau,4Jonathan Rosand,5Thomas W.K. Battey,5Sebastian Koch,6Mario Perez,6Michael James,7Jessica McFarlin,8Jennifer Osborne,4Daniel Woo,9Steven Kittner,2Kevin Sheth1
1New Haven, CT, USA, 2Baltimore, MD, USA, 3Winston-Salem, NC, USA, 45Boston, MA, USA, 6Miami, FL, USA, 7Durham, NC, USA, 8Raleigh, NC, USA, 9Cincinnati, OH, USA
OBJECTIVE: The ICH and FUNC Scores have superior accuracy, compared to the early clinical judgment of physicians and nurses, with regards to the prediction of the Modified Rankin Scale (mRS) achieved by ICH patients at 3 months.
BACKGROUND: The ICH and FUNC Scores are clinical scales designed to predict functional outcome and mortality for intracerebral hemorrhage (ICH) patients.
DESIGN/METHODS: We conducted a prospective study at 5 centers. For each consecutive adult patient admitted with primary ICH, one physician and one nurse on the treatment team were asked for prediction of mRS at 3 months. All predictions were collected within 24 hours of admission. ICH and FUNC Scores on admission and blinded outcomes at 3 months were obtained, in part using data from the ongoing Ethnic/Racial Variations with ICH (ERICH) project. Predictive ability was measured by Spearman's rank correlation (r).
RESULTS: For a total of 100 patients, 100 physicians (75 attendings, 25 trainees) and 100 nurses gave predictions. In order of strength of association with 3-month mRS, correlations were attending physicians r = 0.81, nurses r = 0.72, and trainees r = 0.66. None of these groups were statistically superior (p > 0.10). However, nurses (p = 0.015) and attending physicians (p = 0.002), but not trainees (p = 0.57), were superior in their predictive ability over ICH Score (r = 0.55). Similarly, nurses (p = 0.0003) and attending physicians (p < 0.0001), but not trainees (p = 0.27), were superior over FUNC Score (r = -0.46). This accuracy advantage remained when examining predictions for (1) only those patients alive at 3 months (n = 65), and (2) only those patients for whom providers indicated that they would not recommend comfort care within the first 24 hours (n = 82).
CONCLUSIONS: The ICH and FUNC Scores did not have superior accuracy, compared to subjective clinical judgment, with regards to prediction of 3-month ICH outcome.
Study Supported by: American Heart Assocation
Category - Cerebrovascular Disease and Interventional Neurology: Intracerebral Hemorrhage
Thursday, May 1, 2014 2:15 PM
S45: Platform Session: Cerebrovascular Disease and Interventional Neurology: Rehabilitation, Recovery, and Complications (1:00 PM-2:45 PM)