Predictive accuracy of physicians' estimates of outcome after severe stroke

• Published in: PloS one Vol. 12; no. 9; p. e0184894
• Main Authors: Geurts, Marjolein, de Kort, Floor A S, de Kort, Paul L M, van Tuijl, Julia H, Kappelle, L Jaap, van der Worp, H Bart
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.09.2017; Public Library of Science (PLoS)
• Subjects: Accuracy; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Care and treatment; Comorbidity; Decision making; Diagnosis; Disability; Estimates; Female; Hemorrhage; Hospitals; Humans; Male; Medical personnel; Medicine and Health Sciences; Middle Aged; Mortality; Neurology; Neurosurgery; Patients; People and Places; Physical Sciences; Physicians; Physicians - psychology; Practice; Predictions; Prospective Studies; Quality of Life; Research and Analysis Methods; Severity of Illness Index; Stroke; Stroke - mortality; Stroke - physiopathology; Survival Rate; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0184894

End-of-life decisions after stroke should be guided by accurate estimates of the patient's prognosis. We assessed the accuracy of physicians' estimates regarding mortality, functional outcome, and quality of life in patients with severe stroke. Treating physicians predicted mortality, functional outcome (modified Rankin scale (mRS)), and quality of life (visual analogue scale (VAS)) at six months in patients with major disabling stroke who had a Barthel Index ≤6 (of 20) at day four. Unfavorable functional outcome was defined as mRS >3, non-satisfactory quality of life as VAS <60. Patients were followed-up at six months after stroke. We compared physicians' estimates with actual outcomes. Sixty patients were included, with a mean age of 72 years. Of fifteen patients who were predicted to die, one actually survived at six months (positive predictive value (PPV), 0.93; 95% CI, 0.66-0.99). Of thirty patients who survived, one was predicted to die (false positive rate (FPR), 0.03; 95%CI 0.00-0.20). Of forty-six patients who were predicted to have an unfavorable outcome, four had a favorable outcome (PPV, 0.93; 95% CI, 0.81-0.98; FPR, 0.30; 95% CI; 0.08-0.65). Prediction of non-satisfactory quality of life was less accurate (PPV, 0.63; 95% CI, 0.26-0.90; FPR, 0.18; 95% CI 0.05-0.44). In patients with severe stroke, treating physicians' estimation of the risk of mortality or unfavorable functional outcome at six months is relatively inaccurate. Prediction of quality of life is even more imprecise.