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Neurology. 2013 Jul 30;81(5):448-55. doi: 10.1212/WNL.0b013e31829d874e. Epub 2013 Jun 28.

JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes.

Author information

1
Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada. saposnikg@smh.ca

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.

PMID:
23897872
PMCID:
PMC3776534
DOI:
10.1212/WNL.0b013e31829d874e
[Indexed for MEDLINE]
Free PMC Article

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