Accuracy of neurovascular fellows' prognostication of outcome after subarachnoid hemorrhage.
OBJECTIVE
The purpose of this study was to determine the accuracy and optimal timing of physician prognostication in patients with subarachnoid hemorrhage, a prototypical neurological disease characterized by variable outcomes and frequent disability.


METHODS
From October 2009 to April 2010, treating neurologists at a tertiary care academic medical center made daily predictions of the modified Rankin Scale at 6 months for consecutive patients with subarachnoid hemorrhage. Actual functional outcomes at 6 months were determined by phone interview and dichotomized into good (modified Rankin Scale 0-2) and poor (modified Rankin Scale 3-6) outcomes. Descriptive statistics were used to assess the accuracy of prognostications. Multiple logistic regression and generalized estimating equations were used to assess changes in prognostication accuracy over time and the relationship between prognostication accuracy and clinical factors.


RESULTS
Physicians made 648 prognostications for 66 patients. Overall accuracy ranged from 78% to 88%. Among patients predicted to have a good outcome, 81% (95% CI, 71%-92%) actually had a good outcome, whereas 88% (95% CI, 77%-99%) of patients predicted to do poorly had poor outcomes. No significant trends were seen in prognostication accuracy over time during the hospital course (P=0.72). Increasing age, infection, mechanical ventilation, hydrocephalus, and seizures all significantly worsened physician accuracy.


CONCLUSIONS
Neurologists were generally but not perfectly accurate in their prognostications of functional outcomes. The accuracy of prognoses did not correlate with the hospital day on which they were made but was affected by clinical factors that can cloud the neurological examination.
Department of Neurology and Neuroscience, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA. ban9003@med.cornell.edu
Babak B
BB
Navi
Hooman
H
Kamel
Charles E
CE
McCulloch
Kazuma
K
Nakagawa
Bharath
B
Naravetla
Asma M
AM
Moheet
Christine
C
Wong
S Claiborne
SC
Johnston
J Claude
JC
Hemphill
Wade S
WS
Smith
D000328:Adult; D000367:Age Factors; D002309:Cardiology / Q000592:standards; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005544:Forecasting; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000150:complications; D007239:Infections / Q000150:complications; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards; D011379:Prognosis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial; D012307:Risk Factors; D012640:Seizures / Q000150:complications; D013345:Subarachnoid Hemorrhage / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome