Cerebrovascular Disease, Ischemic Stroke, Stroke
Conditions
Keywords
stroke, risk score, iScore, outcomes, mortality, disability, institutionalization
Brief summary
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.
Detailed description
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
Interventions
OTHERClinical scenarios
Clinicians will be randomized to a sequence of 5 clinical scenarios with a variable range of expected outcome \[i.e. from low (\<10%) to high (\>50%) expected risk death at 30 days\].
Sponsors
Heart and Stroke Foundation of Ontario
Unity Health Toronto
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Practicing and active physicians managing patients with stroke
Exclusion criteria
* retired physicians * physicians not exposed to care for stroke patients
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 30 Day Mortality or Disability (mRS >3) at discharge | Death after 30 days from ischemic stroke onset or Disability following hospital discharge |
Secondary
| Measure | Time frame |
|---|---|
| Death at 30 days | 30 days |
| Death or institutionalization at discharge | up to 30 days after discharge |
Countries
Canada, United States
Outcome results
None listed