Palliative care · Predicting outcomes
Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After ICU Admission
| Design | Prospective cohort study |
|---|---|
| Treatment | Physician and nurse predictions of 6-month survival and functional outcome |
| Control | Observed outcomes at 6 months |
| Population | 303 patients of 340 approached, median age 62, 57% men, 32% African American; follow-up completed for 299 (99%) |
| Follow-up | 6 months |
| Primary endpoint | Discriminative accuracy of clinician predictions for survival and functional outcomes |
| Result | Follow-up was completed for 299 of 303 patients (99%). Clinician predictions discriminated survival reasonably well but were substantially less accurate for functional outcomes such as cognition and ability to return home. |
| Secondary endpoints | Accuracy by clinician type, confidence and accuracy |
ICU physicians' and nurses' discriminative accuracy in predicting 6-month outcomes of critically ill patients varied depending on the outcome being predicted and confidence of the predictors. Further research is needed to better understand how clinicians derive prognostic estimates of long-term outcomes.
The trial authors, in the published abstract
Directly relevant to conversations held every day at ICU bedsides. Families rarely ask only whether the patient will live; they ask what life will look like — the question clinicians answer least reliably. Worth knowing before offering a confident prognosis.
Detsky ME, Harhay MO, Bayard DF, et al. Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission. JAMA 2017 Jun 6;317(21):2187-2195.