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Abstract
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.
GLOSSARY
- CI=
- confidence interval;
- JURaSSiC=
- Clinician JUdgment vs Risk Score to predict Stroke outComes study;
- mRS=
- modified Rankin Scale score;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- RCSN=
- Registry of the Canadian Stroke Network;
- RPDB=
- Ontario Registered Persons Database
Footnotes
Coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received January 13, 2013.
- Accepted in final form April 22, 2013.
- © 2013 American Academy of Neurology
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