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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the results of the Prediction in Intracerebral Hemorrhage [PICH] study. PICH was a prospective observational cohort study which showed that early clinical judgment by attending physicians and nurses more accurately predict 90-day outcome among patients with acute intracerebral hemorrhage compared with two commonly used validated scales.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDavid Y. Hwang, MD, Yale School of Medicine, New Haven, Connecticut, USA, presented the results of the Prediction in Intracerebral Hemorrhage study [PICH]. PICH was a prospective observational cohort study which showed that early clinical judgment by attending physicians and nurses more accurately predict 90-day outcome among patients with acute ICH compared with two commonly used validated scales\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDetermining accurate prognoses for ICH patients is crucial as it drives early decisions regarding life-sustaining therapy, informs patient and family counseling, and influences ICH research including study design and patient enrollment [Holloway RG et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2013]. Although multiple ICH clinical scales have been developed, none have had their accuracy tested against the early judgment of physicians and nurses. The objective of the PICH study was to compare the accuracy of the ICH Score [Hemphill JC et al. \u003Cem\u003EStroke\u003C\/em\u003E 2001; \u003Cem\u003ENeurology\u003C\/em\u003E 2009] and FUNC score [Rost NS et al. \u003Cem\u003EStroke\u003C\/em\u003E 2008] with subjective clinical judgment for predicting functional outcome at 3 months among patients with acute ICH. Eligible patients included adults participating in the larger Ethnic\/Racial Variations of Intracerebral Hemorrhage (ERICH) study at five centers. Clinician participants comprised of one physician and one nurse caring for each patient. Clinicians were asked to predict the 3-month mRS score for each patient\u2014within 24 hours of each patient admission\u2014and to indicate whether they would recommend comfort care only to the patient\u0027s family. ICH and FUNC scores were calculated for each patient upon admission; a blinded 3-month actual mRS was also obtained via ERICH follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EScores on the ICH scale range from 0 to 6, based on the sum of the scores of 5 components: the Glasgow Coma Scale (GCS) score (counting as 0, 1, or 2 points), ICH volume \u226530 mL, the presence of intraventricular hemorrhage, whether the hemorrhage is of infratentorial origin and, age \u0026lt; or \u226580 years. A score of 6 indicates a high probability for a poor outcome. Among various other outcomes, the ICH score has been validated to predict the probability of achieving functional independence at 90 days. The FUNC score was specifically designed to predict functional independence at 90 days. Scores range from 0 to 11, with a score of 11 indicating the highest probability for favorable outcome. The FUNC score is based on five factors: ICH volume (counting as 0, 2, or 4 points), age (\u0026lt;70, 70 to 79, and \u226580 years; counting as 0, 1, or 2 points), ICH location (lobar, deep, or other; counting as 2, 1, or 0 points), GCS score (counting as 0 or 2 points), and the presence of pre-ICH cognitive impairment.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOf the 405 patients from the ERICH study who were eligible to participate in PICH, 100 were enrolled. Participants were a mean age of 66.8 years; 64% had a GCS score of 13 to 15; the ICH was deep in 53% of patients, lobar in 36%, and infratentorial in 11%. The ICH volume was \u0026lt;30 cc in 70% of patients, between 30 and 60 cc in 16%, and \u0026gt;60 cc in 13%. Among the clinicians, 70% of the physicians were neurologists with 75% of the predictions being made by attending physicians and 25% by trainees. Among the nurses, 71% had a neuroscience specialty.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAlthough all correlations for the clinician predictions and clinical scales with 3-month mRS were significant (p\u0026lt;0.02 for all), the subjective predictions made by both attending physicians and nurses had a higher Spearman\u0027s rank correlation with the actual 3-month mRS than either clinical scale (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/11.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Correlation of Subjective Predictions and Clinical Scales With Actual 3-Month mRS Score\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1599077364\u0022 data-figure-caption=\u0022Correlation of Subjective Predictions and Clinical Scales With Actual 3-Month mRS Score\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/11.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/11.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/11.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14262\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ECorrelation of Subjective Predictions and Clinical Scales With Actual 3-Month mRS Score\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EICH=intracerebral hemorrhage; all p values \u0026lt;0.05 for comparisons between clinician correlations and ICH\/FUNC scores correlations with 3-month mRS. FUNC score correlation is negative since lower score predict poor outcome.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from DY Hwang, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EWhen the 18 patients for whom only comfort care was likely recommended were removed from the analysis, the Spearman\u0027s rank correlation for the subjective predictions remained higher than those for either clinical score (p\u0026lt;0.05). The results were similar when data for only survivors were analyzed.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe study is limited by several factors: the clinician participants making predictions were not formally trained in the mRS, early predictions were difficult to obtain and led to 218 potential patients being excluded, and, finally, the cohort contained many patients with low GCS and ICH volume.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/1\/11.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzpd43\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpd43\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}