Background: Several risk score models are now available to assist clinicians estimate outcomes after an acute ischemic stroke. Limited information is available on the predictive value of these scores compared to real outcomes and clinical judgment.
Objectives: To compare clinician judgment with the use of a validated stroke risk score (iScore) and patients' outcomes.
A convenience sample of 111 practicing clinicians (general and vascular neurologists, internists, and ER physicians) predicted the outcomes of 5 stroke patients based on case summaries. Cases were randomly selected as being representative of the 10 most common clinical scenarios (n=1,415) from a pool of over 12,000 patients admitted to stroke centers in Ontario, Canada. Stroke cases had known clinical presentation, comorbidities, stroke severity, and outcomes.
All participants are active practicing physicians caring for patients with acute stroke. Conditions were standardized to mimic clinical practice.
Main outcomes of interest included 30-day mortality and death or disability at discharge.
Secondary outcome: death or institutionalization at discharge
- Clinical scenarios Other
Intervention Desc: Clinicians will be randomized to a sequence of 5 clinical scenarios with a variable range of expected outcome [i.e. from low (<10%) to high (>50%) expected risk death at 30 days]. ARM 1: Kind: Experimental Label: Randomized clinical scenarios Description: Clinicians are randomized to a sequence of 5 clinical scenarios
- Masking: Double Blind (Investigator, Outcomes Assessor)
- Purpose: Diagnostic
- Endpoint: Efficacy Study
- Intervention: Single Group Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||Death or disability (mRS >3) at discharge||up to 30 days after discharge||No|
|Secondary||Death at 30 days||30 days||No|
|Secondary||Death or institutionalization at discharge||up to 30 days after discharge||No|
|Primary||30 Day Mortality or Disability (mRS >3) at discharge||Death after 30 days from ischemic stroke onset or Disability following hospital discharge||No|