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Published, Version of Record (VoR)Open Access (License Unspecified), Open
Journal article
Variability in physician prognosis and recommendations after intracerebral hemorrhage
Neurology, v 86(20), pp 1864-1871
17 May 2016
PMID: 27164665
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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Details
- Title
- Variability in physician prognosis and recommendations after intracerebral hemorrhage
- Creators
- Darin B. Zahuranec - University of MichiganAngela Fagerlin - VA Center for Clinical Management ResearchBrisa N. Sanchez - University of MichiganMeghan E. Roney - Brown UniversityBradford B. Thompson - University of MichiganAndrea Fuhrel-Forbis - University of MichiganLewis B. Morgenstern - University of Michigan
- Publication Details
- Neurology, v 86(20), pp 1864-1871
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Grant note
- CTSA: UL1RR024986 / Michigan Institute for Clinical & Health Research KAG038731 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) UL1RR024986 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) K23AG038731 / NATIONAL INSTITUTE ON AGING; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000376782000007
- Scopus ID
- 2-s2.0-84969195204
- Other Identifier
- 991020100212104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology