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Study: Stroke treatment varies widely between doctors

Some doctors suggested completely different courses of treatment for the same patient, researchers report.

By Stephen Feller
Study: Stroke treatment varies widely between doctors
The wide variability of doctor decision on treatment in a study with hypothetical stroke patients raised concerns among researchers, suggesting getting the right doctor is as important to stroke recovery as getting to a stroke treatment center. Photo by Syda Productions/Shutterstock

ANN ARBOR, Mich., May 6 (UPI) -- In addition to where one has a stroke determining outcome, a recent survey of several thousand doctors suggests what physician one gets can also cause wide variation in treatment.

Researchers at the University of Michigan found doctors made significantly different decisions when presented with two stroke cases, according to a study published in the journal of Neurology.

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Previous studies have shown stroke treatment can vary from hospital to hospital, depending on drugs, staff training or determination as a stroke center, but the new study is focused entirely on decisions by doctors.

Depending on the patient, stroke treatment ranges from aggressive action to clear clots and instigate healing in the brain to making patients comfortable because recovery is not possible.

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There are guidelines and risk factors for certain types of stroke patient treatment, information that appeared in the study to help doctors who were informed of them, though this was not necessarily reassuring to the researchers.

"Do we really know what we think we know when making these predictions?" Dr. Darin Zahuranec, a neurologist at the University of Michigan, said in a press release. "My hope for physicians is that we really understand the impact of our prognostic statements."

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For the study, the researchers interviewed 742 doctors, 32 percent of whom were neurosurgeons and 17 percent women, asking them to review stroke patient case records, determining their 30-day mortality risk and recommendations for initial treatment intensity.

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The researchers found responses covered the full range of possible treatment options -- some offered comfort because of no chance of recovery, while others recommended the most intensive treatment available, for the same patient -- with no demographic or personality characteristics of doctors appearing to affect their medical judgement.

For some doctors and some patients, prognostic scores also were included with patient records, which helped some doctors make decisions. The study also showed neurosurgeons were more optimistic about mortality than neurologists, and doctors who saw more cases were more pessimistic than those who'd seen fewer.

"There's a lot of variability across centers in terms of how these patients are treated," Zahuranec said, leading him to suggest doctors at least slow down when considering treatment options to make sure they are selecting the best course.

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