RT Journal Article
SR Electronic
T1 Variability in physician prognosis and recommendations after intracerebral hemorrhage
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1864
OP 1871
DO 10.1212/WNL.0000000000002676
VO 86
IS 20
A1 Zahuranec, Darin B.
A1 Fagerlin, Angela
A1 Sánchez, Brisa N.
A1 Roney, Meghan E.
A1 Thompson, Bradford B.
A1 Fuhrel-Forbis, Andrea
A1 Morgenstern, Lewis B.
YR 2016
UL http://n.neurology.org/content/86/20/1864.abstract
AB Objective: To assess physician prognosis and treatment recommendations for intracerebral hemorrhage (ICH) and to determine the effect of providing physicians a validated prognostic score.Methods: A written survey with 2 ICH scenarios was completed by practicing neurologists and neurosurgeons. Selected factors were randomly varied (patient older vs middle age, Glasgow Coma Scale [GCS] score 7T vs 11, and presence vs absence of a validated prognostic score). Outcomes included predicted 30-day mortality and recommendations for initial treatment intensity (6-point scale ranging from 1 = comfort only to 6 = full treatment).Results: A total of 742 physicians were included (mean age 52, 32% neurosurgeons, 17% female). Physician predictions of 30-day mortality varied widely (mean [range] for the 4 possible combinations of age and GCS were 23% [0%–80%], 35% [0%–100%], 48% [0%–100%], and 58% [5%–100%]). Treatment recommendations also varied widely, with responses encompassing the full range of response options for each case. No physician demographic or personality characteristics were associated with treatment recommendations. Providing a prognostic score changed treatment recommendations, and the effect differed across cases. When the prognostic score suggested 0% chance of functional independence (76-year-old with GCS 7T), the likelihood of treatment limitations was increased (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.12–2.33) compared to no prognostic score. Conversely, if the score suggested a 66% chance of independence (63-year-old with GCS 11), treatment limitations were less likely (OR 0.62, 95% CI 0.43–0.88).Conclusions: Physicians vary substantially in ICH prognostic estimates and treatment recommendations. This variability could have a profound effect on life and death decision-making and treatment for ICH.CI=confidence interval; GCS=Glasgow Coma Scale; ICH=intracerebral hemorrhage; OR=odds ratio