Accurate outcome predictions for intracerebral hemorrhage patients are more likely than inaccurate predictions to be influenced by co-morbidities not included in clinical scales (I2-5D)

OBJECTIVE: We hypothesized that accurate physician predictions of functional outcome for intracerebral hemorrhage (ICH) patients are more likely than inaccurate predictions to incorporate decision-making factors outside of the variables comprising the ICH and FUNC Scores. BACKGROUND: Clinical scales for ICH, such as the ICH and FUNC Scores, utilize a limited number of variables for outcome prediction. The variables that physicians incorporate into subjective predictions of ICH outcome and how they relate to predictive accuracy are unknown. DESIGN/METHODS: For each consecutive adult patient admitted with primary ICH at 5 centers, one physician on the treatment team was surveyed for a prediction of modified Rankin Scale (mRS) at 3 months. All predictions were prospectively collected within 24 hours of admission. Physicians were also asked to indicate up to 10 factors influencing their prediction. Accuracy was defined as an exact prediction of the 3-month mRS. The frequency of recurring factors listed by physicians were calculated for both the accurate and inaccurate predictions and compared using Fisher’s exact test. RESULTS: We collected 38 accurate and 86 inaccurate predictions for 124 ICH patients. There was no difference between groups with regards to the proportion of respondents listing age, ICH volume, or general clinical exam on admission as factors. However, 16 (42.1[percnt]) of the accurate surveys listed the patient’s general co-morbidities as a factor in prediction, compared to 20 (23.3[percnt]) of inaccurate surveys (p = 0.05). Listing of pre-morbid functional status as a factor also trended towards a higher percentage in the accurate survey group (n = 7, 18.4[percnt], versus n = 6, 7.0[percnt]; p = 0.11). CONCLUSIONS: Accurate predictions of ICH outcome are more likely than inaccurate predictions to factor in general patient co-morbidities, which are not included in ICH or FUNC Score calculation. Study Supported by: AHA Clinical Research Training Award and NINDS U-01-NS069763 Disclosure: Dr. Hwang has received personal compensation for activities with Bayer HealthCare as a consultant. Dr. Dell has nothing to disclose. Dr. Sparks has nothing to disclose. Dr. Watson has nothing to disclose. Dr. Langefeld has nothing to disclose. Dr. Comeau has nothing to disclose. Dr. Rosand has nothing to disclose. Dr. Battey has nothing to disclose. Dr. Koch has nothing to disclose. Dr. Perez has nothing to disclose. Dr. James has received personal compensation for activities with Hospira and Cephalogics as a consultant and/or speaker. Dr. McFarlin has nothing to disclose. Dr. Osborne has received research support from the National Institutes of Health. Dr. Woo has received research support from the National Institutes of Health. Dr. Kittner has nothing to disclose. Dr. Sheth has received research support from the American Academy of Neurology Foundation, the American Heart Association, the Passano Foundation, and Remedy Pharmaceuticals.