Doctors and nurses subjective predictions of 6-month outcome compared to actual 6-month outcome for adult patients with spontaneous intracerebral haemorrhage (ICH) in neurocritical care: An observational study

Siobhan Mc Lernon; Daniel Frings; Louise Terry; Rob Simister; Simone Browning; Helen Burgess; Josenile Chua; Ugan Reddy; David J. Werring

eNeurologicalSci (Mar 2024)

Doctors and nurses subjective predictions of 6-month outcome compared to actual 6-month outcome for adult patients with spontaneous intracerebral haemorrhage (ICH) in neurocritical care: An observational study

Siobhan Mc Lernon,
Daniel Frings,
Louise Terry,
Rob Simister,
Simone Browning,
Helen Burgess,
Josenile Chua,
Ugan Reddy,
David J. Werring

Affiliations

Siobhan Mc Lernon: Stroke Research Centre, University College London, Institute of Neurology, London, UK; London South Bank University, School of Health and Social Care, London, UK; Corresponding author at: School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 OAA, UK.
Daniel Frings: London South Bank University, School of Applied Sciences, London, UK
Louise Terry: London South Bank University, School of Health and Social Care, London, UK
Rob Simister: Stroke Research Centre, University College London, Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK; University College London Hospital NHS Foundation Trust, Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, UK
Simone Browning: University College London Hospital NHS Foundation Trust, Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, UK
Helen Burgess: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
Josenile Chua: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
Ugan Reddy: Stroke Research Centre, University College London, Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
David J. Werring: Stroke Research Centre, University College London, Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK

Journal volume & issue: Vol. 34
p. 100491

Abstract

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Background: Acute spontaneous intracerebral haemorrhage is a devastating form of stroke. Prognostication after ICH may be influenced by clinicians' subjective opinions. Purpose: To evaluate subjective predictions of 6-month outcome by clinicians' for ICH patients in a neurocritical care using the modified Rankin Scale (mRS) and compare these to actual 6-month outcome. Method: We included clinicians' predictions of 6-month outcome in the first 48 h for 52 adults with ICH and compared to actual 6-month outcome using descriptive statistics and multilevel binomial logistic regression. Results: 35/52 patients (66%) had a poor 6-month outcome (mRS 4–6); 19/52 (36%) had died. 324 predictions were included. For good (mRS 0–3) versus poor (mRS 4–6), outcome, accuracy of predictions was 68% and exact agreement 29%. mRS 6 and mRS 4 received the most correct predictions. Comparing job roles, predictions of death were underestimated, by doctors (12%) and nurses (13%) compared with actual mortality (36%). Predictions of vital status showed no significant difference between doctors and nurses: OR = 1.24 {CI; 0.50–3.05}; (p = 0.64) or good versus poor outcome: OR = 1.65 {CI; 0.98–2.79}; (p = 0.06). When predicted and actual 6-month outcome were compared, job role did not significantly relate to correct predictions of good versus poor outcome: OR = 1.13 {CI;0.67–1.90}; (p = 0.65) or for vital status: OR = 1.11 {CI; 0.47–2.61}; p = 0.81). Conclusions: Early prognostication is challenging. Doctors and nurses were most likely to correctly predict poor outcome but tended to err on the side of optimism for mortality, suggesting an absence of clinical nihilism in relation to ICH.

Published in eNeurologicalSci

ISSN: 2405-6502 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: https://www.journals.elsevier.com/eneurologicalsci/

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