title: JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes.
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.
authors.affiliation: Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada. saposnikg@smh.ca
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Robert
authors.initials: R
authors.lastname: Cote
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Stavroula
authors.initials: S
authors.lastname: Raptis
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Thorpe
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D016896:Treatment Outcome; D055815:Young Adult
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