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Updated: Mar 21, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Variability in physician prognosis and recommendations after intracerebral hemorrhage
Darin B Zahuranec1, Angela Fagerlin2, Brisa N Sánchez2
1From the Stroke Program, Department of Neurology (D.B.Z., L.B.M.), Center for Bioethics and Social Sciences in Medicine (D.B.Z., A.F., M.E.R., A.F.-F.), Department of Internal Medicine (A.F.), and Department of Emergency Medicine (L.B.M.), University of Michigan Medical School, Ann Arbor; VA Ann Arbor Center for Clinical Management Research (A.F.); Departments of Biostatistics (B.N.S.) and Epidemiology (L.B.M.), University of Michigan School of Public Health, Ann Arbor; and Departments of Neurology and Neurosurgery (B.B.T.), Alpert Medical School at Brown University, Providence, RI. zdarin@umich.edu.
Objective:
To assess physician prognosis and treatment recommendations for intracerebral hemorrhage (ICH) and to determine the effect of providing physicians a validated prognostic score.
Methods:
A written survey with 2 ICH scenarios was completed by practicing neurologists and neurosurgeons. Selected factors were randomly varied (patient older vs middle age, Glasgow Coma Scale [GCS] score 7T vs 11, and presence vs absence of a validated prognostic score). Outcomes included predicted 30-day mortality and recommendations for initial treatment intensity (6-point scale ranging from 1 = comfort only to 6 = full treatment).
Results:
A total of 742 physicians were included (mean age 52, 32% neurosurgeons, 17% female). Physician predictions of 30-day mortality varied widely (mean [range] for the 4 possible combinations of age and GCS were 23% [0%-80%], 35% [0%-100%], 48% [0%-100%], and 58% [5%-100%]). Treatment recommendations also varied widely, with responses encompassing the full range of response options for each case. No physician demographic or personality characteristics were associated with treatment recommendations. Providing a prognostic score changed treatment recommendations, and the effect differed across cases. When the prognostic score suggested 0% chance of functional independence (76-year-old with GCS 7T), the likelihood of treatment limitations was increased (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.12-2.33) compared to no prognostic score. Conversely, if the score suggested a 66% chance of independence (63-year-old with GCS 11), treatment limitations were less likely (OR 0.62, 95% CI 0.43-0.88).
Conclusions:
Physicians vary substantially in ICH prognostic estimates and treatment recommendations. This variability could have a profound effect on life and death decision-making and treatment for ICH.
