Is ‘gut feeling’ by medical staff better than validated scores in estimation of mortality in a medical intensive care unit? – The prospective FEELING-ON-ICU study

Radtke, Anne; Pfister, Roman; Kuhr, Kathrin; Kochanek, Matthias; Michels, Guido

doi:10.1016/j.jcrc.2017.05.029

Cited by 13 publications

(10 citation statements)

References 25 publications

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“…It is obvious that the decision-making process in such instances should be preceded by an accurate and less time-consuming assessment, even more so if we are faced with a vulnerable patient weakened by comorbidities [ 25 ]. The evaluation of surgical risks plays a pivotal role and the reliability of the so-called “gut-feeling” has not been no longer suitable due to its lack of reproducibility and, thereby, it has been upgraded with a lot of risk stratification tools developed across the years and validated in different medical and surgical populations [ 26 , 27 ]. Nevertheless, there is no an ideal model particularly when elderly frail patients were considered.…”

Section: Discussionmentioning

confidence: 99%

The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Lucarini

Sganga²,

Agresta

et al. 2020

Aging Clin Exp Res

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Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

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Section: Discussionmentioning

confidence: 99%

The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Lucarini

Sganga²,

Agresta

et al. 2020

Aging Clin Exp Res

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“…Previous literature suggests that physicians' predictions of critically ill patients' mortality perform well in comparison with objective predictive tools. 10,11,[22][23][24][25] Our results thus suggest that the process driving physician's judgements are potentially driven by these universal poor prognostic factors, such as age, higher severity of illness, and the presence of life limiting diseases, like malignancy. 4,5 An interesting aspect of our study is the potential clustering effect of the predictions based on the individual physicians.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with physicians’ predictions of six-month mortality in critically ill patients

Ferreyro

Harhay

Detsky

2019

Journal of the Intensive Care Society

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Background Physician's estimates of a patient's prognosis are an important component in shared decision-making. However, the variables influencing physician's judgments are not well understood. We aimed to determine which physician and patient factors are associated with physicians' predictions of critically ill patients' six-month mortality and the accuracy and confidence of these predictions. Methods Prospective cohort study evaluating physicians' predictions of six-month mortality. Using univariate and multivariable generalized estimating equations, we assessed the association between baseline physician and patient characteristics with predictions of six-month death, as well as accuracy and confidence of these predictions. Results Our cohort was comprised 300 patients and 47 physicians. Physicians were asked to predict if patients would be alive or dead at six months and to report their confidence in these predictions. Physicians predicted that 99 (33%) patients would die. The key factors associated with both the direction and accuracy of prediction were older age of the patient, the presence of malignancy, being in a medical ICU, and higher APACHE III scores. The factors associated with lower confidence included older physician age, being in a medical ICU and higher APACHE III score. Conclusions Patient level factors are associated with predictions of mortality at six months. The accuracy and confidence of the predictions are associated with both physician and patients' factors. The influence of these factors should be considered when physicians reflect on how they make predictions for critically ill patients.

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“…While it may be assumed that clinical signs, symptoms, and laboratory results should be the only evidence used by clinicians in their diagnostic reasoning (in accordance with the standards of evidence-based medicine), recent studies show wide recognition of the role of non-analytical, intuitive reasoning ( 31 – 34 ) and its added value in diagnosis of serious infections in children ( 12 , 35 ), and gastrointestinal bleeding ( 36 ), cancer ( 37 , 38 ), and other life- or limb-threatening conditions ( 39 – 41 ). Specifically, a clinician's “gut feeling of something being wrong” even if the clinical signs do not indicate serious illness has been associated with significantly increased risk for serious illness in febrile children presenting to primary care ( 35 ) and also identified as a key variable in a CPM derived from a primary care cohort ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department

et al. 2022

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ObjectiveDevelopment and validation of clinical prediction model (CPM) for serious bacterial infections (SBIs) in children presenting to the emergency department (ED) with febrile illness, based on clinical variables, clinician's “gut feeling,” and “sense of reassurance.Materials and MethodsFebrile children presenting to the ED of Children's Clinical University Hospital (CCUH) between April 1, 2017 and December 31, 2018 were enrolled in a prospective observational study. Data on clinical signs and symptoms at presentation, together with clinician's “gut feeling” of something wrong and “sense of reassurance” were collected as candidate variables for CPM. Variable selection for the CPM was performed using stepwise logistic regression (forward, backward, and bidirectional); Akaike information criterion was used to limit the number of parameters and simplify the model. Bootstrapping was applied for internal validation. For external validation, the model was tested in a separate dataset of patients presenting to six regional hospitals between January 1 and March 31, 2019.ResultsThe derivation cohort consisted of 517; 54% (n = 279) were boys, and the median age was 58 months. SBI was diagnosed in 26.7% (n = 138). Validation cohort included 188 patients; the median age was 28 months, and 26.6% (n = 50) developed SBI. Two CPMs were created, namely, CPM1 consisting of six clinical variables and CPM2 with four clinical variables plus “gut feeling” and “sense of reassurance.” The area under the curve (AUC) for receiver operating characteristics (ROC) curve of CPM1 was 0.744 (95% CI, 0.683–0.805) in the derivation cohort and 0.692 (95% CI, 0.604–0.780) in the validation cohort. AUC for CPM2 was 0.783 (0.727–0.839) and 0.752 (0.674–0.830) in derivation and validation cohorts, respectively. AUC of CPM2 in validation population was significantly higher than that of CPM1 [p = 0.037, 95% CI (−0.129; −0.004)]. A clinical evaluation score was derived from CPM2 to stratify patients in “low risk,” “gray area,” and “high risk” for SBI.ConclusionBoth CPMs had moderate ability to predict SBI and acceptable performance in the validation cohort. Adding variables “gut feeling” and “sense of reassurance” in CPM2 improved its ability to predict SBI. More validation studies are needed for the assessment of applicability to all febrile patients presenting to ED.

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Is ‘gut feeling’ by medical staff better than validated scores in estimation of mortality in a medical intensive care unit? – The prospective FEELING-ON-ICU study

Cited by 13 publications

References 25 publications

The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Factors associated with physicians’ predictions of six-month mortality in critically ill patients

Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department

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