Abstract
Background: Limited information is available evaluating the accuracy of clinician judgment compared with predictive stroke outcome scores. Objectives: To compare the accuracies of clinician judgment and a validated stroke risk score (iScore) for predicting stroke patient outcomes. Methods: A convenience sample of 111 practicing clinicians (general and stroke neurologists, internists, and ER physicians) predicted the outcomes of 5 stroke patients based on case summaries. Cases were randomly selected as being representative of the 10 most common clinical scenarios (n=1,415) from a pool of over 12,000 patients admitted to stroke centers in Ontario, Canada. Stroke cases had known clinical presentation, comorbidities, stroke severity, and outcomes. Main outcomes: 30 day mortality and/or disability at discharge. Results: Evaluators’ mean age was 40±12 years; 55 (50%) were active staff physicians, 47 (42%) neurologists and 8 (7%) board certified stroke neurologists. The mean number of stroke patients assessed per physician/yr was 98 (±150); 92 (82%) provide acute stroke care (initial 48 hrs). Although on average clinicians were able to estimate stroke patient outcomes accurately (mean absolute difference for death or disability at discharge: 12.8%; 95%CI 9.3%-16.5%) ,there was significant variability in the clinicians’ predictions (Figure A). Specifically, 70-100% of clinicians’ estimates were outside the 95%CI of observed outcomes (Figure B). In contrast, 90% of the iScore-based estimates were within the 95%CI of observed outcomes. Clinicians indicated a low level of confidence (mean 39%) in estimating outcomes. Conclusions: Clinicians with expertise in stroke care made predictions for actual outcomes outside of the 95%CI in 70-100% of cases whereas predictions using the iScore fell outside the 95%CI in less than 10% of cases. The iScore may provide a useful tool to help clinicians gauge a stroke patient’s likely outcome. ClinicalTrials.gov NCT01657279
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