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The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness
To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL). We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of...
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| Published in: | Journal of critical care 2018-02, Vol.43, p.148-155 |
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| Main Authors: | , , , , , , |
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| cites | cdi_FETCH-LOGICAL-c384t-4ae9294bbfc4fa0cfd911d5269f4f9c6a23921bf1ab2770e4f8c370f7849a1523 |
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| container_start_page | 148 |
| container_title | Journal of critical care |
| container_volume | 43 |
| creator | Soliman, Ivo W. Cremer, Olaf L. de Lange, Dylan W. Slooter, Arjen J.C. van Delden, Johannes (Hans) J.M. van Dijk, Diederik Peelen, Linda M. |
| description | To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL).
We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index |
| doi_str_mv | 10.1016/j.jcrc.2017.09.007 |
| format | article |
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We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4.
Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results.
Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome.
•ICU physician prognosis does not match observed outcomes in 1/3 ICU patients•Inaccurate prognoses predominantly due to overoptimistic expectation of outcome•Overoptimism associated with comorbidities, admission type and events at admission</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2017.09.007</identifier><identifier>PMID: 28898744</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Critical care ; Data collection ; Dementia ; Family medical history ; Health related quality of life ; Hospitals ; Illnesses ; Intensive care ; Intuitive physician prognosis ; Long-term outcomes ; Medical prognosis ; Mortality ; Multiple organ dysfunction syndrome ; Patients ; Quality of life ; Subjective prognosis</subject><ispartof>Journal of critical care, 2018-02, Vol.43, p.148-155</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 1, 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-4ae9294bbfc4fa0cfd911d5269f4f9c6a23921bf1ab2770e4f8c370f7849a1523</citedby><cites>FETCH-LOGICAL-c384t-4ae9294bbfc4fa0cfd911d5269f4f9c6a23921bf1ab2770e4f8c370f7849a1523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28898744$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soliman, Ivo W.</creatorcontrib><creatorcontrib>Cremer, Olaf L.</creatorcontrib><creatorcontrib>de Lange, Dylan W.</creatorcontrib><creatorcontrib>Slooter, Arjen J.C.</creatorcontrib><creatorcontrib>van Delden, Johannes (Hans) J.M.</creatorcontrib><creatorcontrib>van Dijk, Diederik</creatorcontrib><creatorcontrib>Peelen, Linda M.</creatorcontrib><title>The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL).
We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4.
Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results.
Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome.
•ICU physician prognosis does not match observed outcomes in 1/3 ICU patients•Inaccurate prognoses predominantly due to overoptimistic expectation of outcome•Overoptimism associated with comorbidities, admission type and events at admission</description><subject>Critical care</subject><subject>Data collection</subject><subject>Dementia</subject><subject>Family medical history</subject><subject>Health related quality of life</subject><subject>Hospitals</subject><subject>Illnesses</subject><subject>Intensive care</subject><subject>Intuitive physician prognosis</subject><subject>Long-term outcomes</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Multiple organ dysfunction syndrome</subject><subject>Patients</subject><subject>Quality of life</subject><subject>Subjective prognosis</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kT2P1DAYhC0E4paDP0CBLNHQJNiOk9gSDTrxJZ1Ec9SW47y-e6OsvdjOSvvvz6s9KCiopnlmNJoh5C1nLWd8-Li0i0uuFYyPLdMtY-MzsuN9PzZq4P1zsmNKdY2Wkl-RVzkvrIJd178kV0IprUYpdyTcPQC1E65YTjR6iqFAyHgE6mwCugUs9PBwyujQhkxLpJAL7m0BusZw3xRIe3pI8T7EjLnaad7SEY8x5XOcS1jQ2ZXiugbI-TV54e2a4c2TXpNfX7_c3Xxvbn9--3Hz-bZxnZKlkRa00HKavJPeMudnzfnci0F76bUbrOi04JPndhLjyEB65bqR-VFJbXkvumvy4ZJbq_3eamWzx-xgXW2AuGXDdacGJqQeKvr-H3SJWwq1XaVUJ6XUqq-UuFAuxZwTeHNIdYZ0MpyZ8xtmMec3zPkNw7Spb1TTu6fobdrD_NfyZ_4KfLoAULc4IiSTHUJwMGMCV8wc8X_5jz9PnNE</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Soliman, Ivo W.</creator><creator>Cremer, Olaf L.</creator><creator>de Lange, Dylan W.</creator><creator>Slooter, Arjen J.C.</creator><creator>van Delden, Johannes (Hans) J.M.</creator><creator>van Dijk, Diederik</creator><creator>Peelen, Linda M.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201802</creationdate><title>The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness</title><author>Soliman, Ivo W. ; Cremer, Olaf L. ; de Lange, Dylan W. ; Slooter, Arjen J.C. ; van Delden, Johannes (Hans) J.M. ; van Dijk, Diederik ; Peelen, Linda M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-4ae9294bbfc4fa0cfd911d5269f4f9c6a23921bf1ab2770e4f8c370f7849a1523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Critical care</topic><topic>Data collection</topic><topic>Dementia</topic><topic>Family medical history</topic><topic>Health related quality of life</topic><topic>Hospitals</topic><topic>Illnesses</topic><topic>Intensive care</topic><topic>Intuitive physician prognosis</topic><topic>Long-term outcomes</topic><topic>Medical prognosis</topic><topic>Mortality</topic><topic>Multiple organ dysfunction syndrome</topic><topic>Patients</topic><topic>Quality of life</topic><topic>Subjective prognosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soliman, Ivo W.</creatorcontrib><creatorcontrib>Cremer, Olaf L.</creatorcontrib><creatorcontrib>de Lange, Dylan W.</creatorcontrib><creatorcontrib>Slooter, Arjen J.C.</creatorcontrib><creatorcontrib>van Delden, Johannes (Hans) J.M.</creatorcontrib><creatorcontrib>van Dijk, Diederik</creatorcontrib><creatorcontrib>Peelen, Linda M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soliman, Ivo W.</au><au>Cremer, Olaf L.</au><au>de Lange, Dylan W.</au><au>Slooter, Arjen J.C.</au><au>van Delden, Johannes (Hans) J.M.</au><au>van Dijk, Diederik</au><au>Peelen, Linda M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2018-02</date><risdate>2018</risdate><volume>43</volume><spage>148</spage><epage>155</epage><pages>148-155</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL).
We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4.
Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results.
Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome.
•ICU physician prognosis does not match observed outcomes in 1/3 ICU patients•Inaccurate prognoses predominantly due to overoptimistic expectation of outcome•Overoptimism associated with comorbidities, admission type and events at admission</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28898744</pmid><doi>10.1016/j.jcrc.2017.09.007</doi><tpages>8</tpages></addata></record> |
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| language | eng |
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| source | ScienceDirect Freedom Collection |
| subjects | Critical care Data collection Dementia Family medical history Health related quality of life Hospitals Illnesses Intensive care Intuitive physician prognosis Long-term outcomes Medical prognosis Mortality Multiple organ dysfunction syndrome Patients Quality of life Subjective prognosis |
| title | The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness |
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