Clinician JUdgment Versus Risk Score to Predict Stroke outComes: The JURASSIC Clinical Trial

Unity Health Toronto111 enrolled

Overview

Background: Several risk score models are now available to assist clinicians estimate outcomes after an acute ischemic stroke. Limited information is available on the predictive value of these scores compared to real outcomes and clinical judgment. Objectives: To compare clinician judgment with the use of a validated stroke risk score (iScore) and patients' outcomes.

A convenience sample of 111 practicing clinicians (general and vascular neurologists, internists, and ER physicians) predicted the outcomes of 5 stroke patients based on case summaries. Cases were randomly selected as being representative of the 10 most common clinical scenarios (n=1,415) from a pool of over 12,000 patients admitted to stroke centers in Ontario, Canada. Stroke cases had known clinical presentation, comorbidities, stroke severity, and outcomes. All participants are active practicing physicians caring for patients with acute stroke. Conditions were standardized to mimic clinical practice. Main outcomes of interest included 30-day mortality and death or disability at discharge. Secondary outcome: death or institutionalization at discharge

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

DOUBLE

Enrollment

111

Conditions

Stroke Ischemic Stroke Cerebrovascular Disease

Interventions

Clinical scenariosOTHER

Clinicians will be randomized to a sequence of 5 clinical scenarios with a variable range of expected outcome \[i.e. from low (\<10%) to high (\>50%) expected risk death at 30 days\].

Eligibility

Sex: ALLMin age: 20 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Practicing and active physicians managing patients with stroke Exclusion Criteria: * retired physicians * physicians not exposed to care for stroke patients

Locations (4)

Duke University Medical Center

Durham, North Carolina, United States

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

St Michael's Hospital

Toronto, Ontario, Canada

McGill University Health Centre

Montreal, Quebec, Canada

Outcomes

Primary Outcomes

30 Day Mortality or Disability (mRS >3) at discharge

Time frame: Death after 30 days from ischemic stroke onset or Disability following hospital discharge

Secondary Outcomes

Death at 30 days

Time frame: 30 days

Death or institutionalization at discharge

Time frame: up to 30 days after discharge

Data from ClinicalTrials.gov

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