Accuracy of predictions of survival at admission to the intensive care unit

Barrera, Rafael; Nygard, Stephen; Sogoloff, Helen; Groeger, Jeffrey S.; Wilson, Roger S.

doi:10.1053/jcrc.2001.21794

Cited by 26 publications

(14 citation statements)

References 9 publications

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“…However, differences in physicians' experience, population studied, severity of illness, and time frame of the assessment may significantly affect the consistency and accuracy of physician predictions [4,5]. Furthermore, none of these previous studies have assessed whether physicians can reliably predict the long-term survival of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: A linked-data cohort study

Litton

Webb

2012

Journal of Critical Care

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Section: Introductionmentioning

confidence: 99%

Comparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: A linked-data cohort study

Litton

Webb

2012

Journal of Critical Care

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“…Clinicians planning treatment for a hypothetical patient with a COPD exacerbation divide almost equally between those choosing intubation (58%) and those choosing non-intubation (42%). 12 Our study differs in that the data are normally distributed, suggesting that at the extremes practice between clinicians is highly variable. This has substantial implications for patients, with practice varying between units or even within one unit according to the clinician on call that day.…”

Section: Discussionmentioning

confidence: 68%

“…Intensivists are more accurate in predicting ICU survival. 12 The data show a very wide variation in practice between individual clinicians. Some clinicians consider ventilation more readily than others in any situation.…”

Section: Discussionmentioning

confidence: 98%

Clinical decision-making and mechanical ventilation in patients with respiratory failure due to an exacerbation of COPD

2003

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-This paper reports a study undertaken to determine whether differences exist in practice between respiratory physicians, general physicians and intensivists or between individual clinicians in initiating mechanical ventilation in respiratory failure due to chronic obstructive pulmonary disease (COPD), the factors influencing decisionmaking and their relation to the evidence base. Of 725 questionnaires sent to clinicians, 350 (48%) were completed and analysed. Twenty-five variables were included which clinicians scored 0-3 according to their perceived relevance in the decision. The sum of all the responses was calculated for each clinician: respiratory 15-68, general 12-65, intensivists 16-64. The most important variables in withholding ventilation were lung cancer inoperable due to COPD, and nursing home resident. The least important variables were treated depression and osteoporosis. No significant differences existed in practice between specialties but there were great differences between individuals' practices. Clinicians were influenced by similar factors, but these did not reflect documented poor outcome predictors. Guidelines are needed. KEY WORDS: chronic obstructive pulmonary disease (COPD), decision-making, intensive care, ventilationChronic obstructive pulmonary disease (COPD) is progressive and has substantial morbidity and mortality. Declining lung function, acute exacerbations with respiratory compromise, and deteriorating quality of life characterise its course. Patients with exacerbations requiring mechanical ventilation have a hospital mortality of 11-82%. 1-6 Survivors often do not regain their previous function. 2,5 So the wisdom of instituting invasive ventilation in such circumstances can be finely balanced.Some perceive that physicians and intensivists make such decisions differently, and certain specialties do consider life-sustaining treatment more readily than others. 7 Physicians behave variably in withholding treatment for different conditions with similarly poor prognosis -ventilatory support is offered more often for end-stage COPD than for cancer. 7 Outcome predictors in patients requiring invasive ventilation should influence rational practice. Studies show variable prognostic factors 2-6 making it difficult to identify outcome predictors. The recurring independent variables found in more than one study to predict poor prognosis are low serum albumin, 2,4,6 significant comorbidities and high APACHE 11 scores. 3,5,6 (The Acute Physiology and Chronic Health Evaluation (APACHE) score is an index based on physiological variables in critically ill patients that correlates with survival.)This study investigates the perceived and real differences in opinion between intensivists, respiratory and general physicians, the magnitude of variance between individual clinicians, and the comorbidities that most influence decision-making. MethodA questionnaire was circulated by post to 600 consultants (200 respiratory physicians, 200 general physicians and 200 intensivists) selected randoml...

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“…The confrontation between the classically expertjudgement-based ''art of medicine'' point of view and that of ''evidence-based medicine'' is neither the focus nor the concern of the present study; however, the need to merge the two effectively in computer-based support systems is of concern across many health care disciplines, most particularly in critical care, to allow for better triage and distribution of resources [23][24][25][26]. Within this general debate, the clearest role for math-based systems development-computer modelling and instrumentation based on this work-is in improved data-gathering and decision-assist tools [27,28].…”

Section: Discussionmentioning

confidence: 95%

Assessing trauma care provider judgement in the prediction of need for life-saving interventions

Anazodo

Murthi

Frank³

et al. 2015

Injury

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Accuracy of predictions of survival at admission to the intensive care unit

Cited by 26 publications

References 9 publications

Comparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: A linked-data cohort study

Comparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: A linked-data cohort study

Clinical decision-making and mechanical ventilation in patients with respiratory failure due to an exacerbation of COPD

Assessing trauma care provider judgement in the prediction of need for life-saving interventions

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