NDLI: Why Clinicians Prognosticate Stroke Patients Poorly: Results from the Clinician Judgment versus Risk Score to Predict Stroke Outcomes Randomized Study.

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Why Clinicians Prognosticate Stroke Patients Poorly: Results from the Clinician Judgment versus Risk Score to Predict Stroke Outcomes Randomized Study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Persaud, Nav Thorpe, Kevin E. Raptis, Stavroula R. Saposnik, Gustavo
Description	Author Affiliation: Persaud N ( Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada); Thorpe KE ( Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada); Raptis SR ( Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada); Saposnik G ( Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada)
Abstract	BACKGROUND: Prognostication after a stroke has important implications for care and for decisions made by patients and their families. It is not clear why clinicians, even experienced stroke neurologists, poorly estimate the risk of disability and death following stroke. METHODS: We analyzed the results from the Clinician Judgment versus Risk Score to predict Stroke Outcomes study in which each clinician estimated the risk of death and the risk of death or disability in 5 case-based ischemic stroke scenarios. We employed a mixed-effect linear model to disentangle the ability of clinicians to discriminate between poor and good prognosis cases (slope) from the calibration of quantitative estimates (intercept), and to assess for any effect of anchoring in the death or disability condition (through a comparison with the death condition). RESULTS: One hundred eleven clinicians made 1665 predictions. Clinicians were able to discriminate between cases with low and high risks of death (slope of .81, 95% confidence interval [CI] .70-.93), but the quantitative estimates were not well calibrated (intercept of 5.14, 95% CI 3.97-6.33). The discrimination was poorer (slope of .67, 95% CI .60-.75), but the calibration was better (intercept of -.34, 95% CI -5.43 to 4.98) in the death or disability estimates. CONCLUSION: Poor stroke prognostication can be explained by poor calibration and an anchoring effect, which are both amenable to specific training interventions.
File Format	HTM / HTML
ISSN	10523057
Issue Number	6
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume Number	25
e-ISSN	15328511
Language	English
Publisher	Elsevier
Publisher Date	2016-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Rehabilitation Neurology (clinical) Surgery Cardiology and Cardiovascular Medicine

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