临床医生对急性脑内出血后死亡和康复的预测准确性:INTERACT3 研究的预设分析。

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Menglu Ouyang, Lu Ma, Xiaoying Chen, Xia Wang, Laurent Billot, Qiang Li, Alejandra Malavera, Xi Li, Paula Muñoz-Venturelli, Asita De Silva, Thang Huy Nguyen, Kolawole W Wahab, Jeyaraj Dural Pandian, Mohammad Wasay, Octavio Marques Pontes-Neto, Carlos Abanto, Antonio Arauz, Chao You, Xin Hu, Lili Song, Craig S Anderson
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引用次数: 0

摘要

简介:准确预测患者的预后是脑内出血(ICH)决策的重要组成部分。我们旨在确定临床医生预测 ICH 患者生存、功能恢复和恢复病前活动的能力:方法:对第三次急性脑出血降压INTEnsive护理捆绑试验(INTERACT3)进行预先指定的二次分析,INTERACT3是一项国际多中心阶梯式分组随机对照试验。在入院时和第 7 天(或出院前)收集了临床医生对预后的看法。预后问题包括:(i) 48 小时和 6 个月后存活的可能性;(ii) 有利的功能结果(恢复行走和自理能力);(iii) 6 个月后恢复正常活动的可能性。临床医生的预测结果与实际结果进行了比较:结果:大多数临床医生(75%)来自神经外科,工作经验中位数为 8 年(IQR 5-14)。在 6305 名存活 48 小时的随机患者中,有 213 人(3.4%)被预测为死亡(阳性预测值 [PPV] 0.99,95% 置信区间 [CI] 0.99-0.99)。在存活 6 个月的 5435 名患者中,有 209 人(3.8%)被预测为死亡(PPV 0.93,95% 置信区间 [CI]0.92-0.93)。对良好功能预后(PPV 0.54,95% CI 0.52-0.56)和恢复正常活动能力(PPV 0.50,95% CI 0.49-0.52)的预测较差。预测准确性因工作年限和执业地区而异:结论:对于 ICH 患者,临床医生对死亡的估计非常准确,但相反,在预测较高水平的功能恢复和活动方面却很差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictive accuracy of clinicians estimates of death and recovery after acute intracerebral hemorrhage: pre-specified analysis in INTERACT3 study.

Introduction: Accurately predicting a patient's prognosis is an important component of decision-making in intracerebral hemorrhage (ICH). We aimed to determine clinicians' ability to predict survival, functional recovery, and return to premorbid activities in patients with ICH.

Methods: Pre-specified secondary analysis of the third INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3), an international, multicenter, stepped-wedge cluster randomized controlled trial. Clinician perspectives on prognosis were collected at hospital admission and Day 7 (or before discharge). Prognosis questions were the likelihood of (i) survival at 48 hours and 6 months, (ii) favorable functional outcome (recovery walking and self-care) and (iii) return to usual activities at 6 months. Clinician predictions were compared with actual outcomes.

Results: Most clinician participants were from neurosurgery (75%) with a median of 8 working years (IQR 5-14) of experience. Of the 6305 randomized patients who survived 48 hours, 213 (3.4%) were predicted to die (positive predictive value [PPV] 0.99, 95% confidence interval [CI] 0.99-0.99). Of 5435 patients who survived 6 months, 209 (3.8%) were predicted to die (PPV 0.93, 95% CI 0.92-0.93). Predictions on favorable functional outcome (PPV 0.54, 95% CI 0.52-0.56) and satisfied ability to return to usual activities (PPV 0.50, 95% CI 0.49-0.52) were poor. Prediction accuracy varied by working years and region of practice.

Conclusions: In patients with ICH, clinician estimates of death are very good but conversely they are poor in predicting higher levels of functional recovery and activities.

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来源期刊
Cerebrovascular Diseases
Cerebrovascular Diseases 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
90
审稿时长
1 months
期刊介绍: A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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