Survey: Severe stroke prognoses differ depending on the doctor

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A survey of physicians across the U.S. found doctors make varied recommendations and very different decisions regarding care after an intracerebral hemorrhage (ICH).

“There’s a lot of variability across centers in terms of how these patients are treated,” said University of Michigan neurologist Darin Zahuranec, MD, principal investigator of a new physician survey published in Neurology. “We wanted to see what role, if any, the physicians may play in that variability, my hope for physicians is that we really understand the impact of our prognostic statements."

Funded by the National Institute on Aging with grant support from the Michigan Institute for Clinical & Health Research, the study included a total of 742 practicing neurologists and neurosurgeons from around the U.S. who were surveyed about the 30-day mortality rate and recommend treatment intensity two ICH scenarios.

Treatment recommendations ranged widely among physicians, with some recommending comfort measures and others suggesting full intensive treatment for the same patient. The physicians rated severity on cases.

“The range of predicted mortality was from 0 percent to 100 percent in most of the cases,” Zahuranec, a member of the University of Michigan’s Institute for Healthcare Policy and Innovation, says. “I was surprised to see that level of variability among physicians.”

When the prognostic score was rated at 0 percent chance of recovery, physicians were more likely to recommend comfort measures. As the percent of severity increased physicians recommended full intensive treatment with the goal of rehabilitation. Zahuranec recommended that physicians should first ask the family about what a good recovery would look to them and what the patient would want, tailoring their recommendations to their feedback.

“These situations are always very difficult for the family and for the physicians,” Zahuranec says. “One thing that can make things easier is when the family has a clear understanding of what the patient would want.”