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Prognostication in Acute Neurological Emergencies.

Kelly L Sloane¹, Julie J Miller², Amanda Piquet³

¹Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|January 10, 2022

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Neurological prognostication in emergency departments is highly variable among physicians. Group predictions, or "wisdom of the crowd," may offer more accurate outcomes for acute neurological conditions.

Area of Science:

Neurology
Emergency Medicine
Medical Prognostication

Background:

Prognostication for acute neurological conditions in the emergency department (ED) relies on clinical experience, scoring systems, and comorbidities.
Accurate prognosis is crucial as it influences decisions regarding life-sustaining therapy withdrawal.
Investigated the consistency of prognostication among neurology physicians for critical neurological conditions.

Purpose of the Study:

To assess the variability and accuracy of neurological prognostication among a diverse group of neurology providers.
To compare the consistency of outcome predictions across different provider roles and expertise levels.

Main Methods:

A simulation exercise involving 120 neurology providers using de-identified clinical, laboratory, and imaging data from five acute neurological cases.

Keywords:

Brain injury Neurological emergencies Neuroprognostication Outcome prediction

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Providers ranked predicted 90-day modified Rankin Scale (mRS) scores for each case.

Compared individual and group-weighted predictions against actual 90-day mRS outcomes.

Main Results:

Individual outcome predictions showed high variability, with accuracy ranging from 2% to 95% compared to actual mRS scores.
The group's weighted outcome prediction matched the actual mRS score in 60% of cases (3 out of 5).
No significant differences in prediction accuracy were found between neurology trainees and faculty, or between subspecialty groups.

Conclusions:

Acute neuro-prognostication is frequently variable and inaccurate among neurology providers.
Experience and subspecialty expertise did not significantly improve prognostication accuracy.
The collective prediction of a group ('wisdom of the crowd') may be more reliable than individual assessments.