Journal Article

The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness

van Delden, Johannes (Hans) J.M., Soliman, Ivo W., de Lange, Dylan W., Cremer, Olaf L., van Dijk, Diederik, Slooter, Arjen J.C., Peelen, Linda M.

2018

Overview

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

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Age Factors / Aged / Cohort Studies / Critical Care / Critical Illness - mortality / Critical Illness - therapy / Data collection / Dementia / Family medical history / Female / Health related quality of life / Hospitals / Humans / Illnesses / Intensive care / Intensive Care Units / Intuitive physician prognosis / Length of Stay / Long-term outcomes / Male / Medical prognosis / Middle Aged / Mortality / Multiple organ dysfunction syndrome / Netherlands / Patient Discharge / Patients / Physicians / Prognosis / Quality of Life / Reproducibility of Results / Subjective prognosis / Survivors