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

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

doi:10.1016/j.jcrc.2017.09.007

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

J Crit Care. 2018 Feb:43:148-155. doi: 10.1016/j.jcrc.2017.09.007. Epub 2017 Sep 6.

Authors

Ivo W Soliman¹, Olaf L Cremer², Dylan W de Lange³, Arjen J C Slooter⁴, Johannes Hans J M van Delden⁵, Diederik van Dijk⁶, Linda M Peelen⁷

Affiliations

¹ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].
² Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].
³ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].
⁴ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].
⁵ Department of Medical Humanities, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].
⁶ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].
⁷ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: [email protected].

PMID: 28898744
DOI: 10.1016/j.jcrc.2017.09.007

Abstract

Purpose: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Critical care; Health related quality of life; Intensive care; Intuitive physician prognosis; Long-term outcomes; Subjective prognosis.

Publication types

Observational Study

MeSH terms

Age Factors
Aged
Cohort Studies
Critical Care
Critical Illness / mortality*
Critical Illness / therapy
Female
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Netherlands
Patient Discharge
Physicians*
Prognosis
Quality of Life*
Reproducibility of Results
Survivors