Antonio Paulo Nassar1, Pedro Caruso2. 1. Intensive Care Unit, AC Camargo Cancer Center, São Paulo-SP, Brazil Discipline of Medical Emergencies, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 2. Intensive Care Unit, AC Camargo Cancer Center, São Paulo-SP, Brazil Pulmonary Division- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Abstract
OBJECTIVE: To evaluate the accuracy of prediction of intensive care unit length of stay made by physicians at patient admission. DESIGN: Prospective cohort study. SETTING: Three medical-surgical intensive care units in an oncology hospital. PATIENTS: All patients admitted between January and December 2014. INTERVENTIONS: None. MAIN OUTCOME MEASUREMENTS: Intensive care unit (ICU) length of stay was estimated by the physicians responsible for patient admission and categorized as <48 h, 2-5 days or more than 5 days. Agreement between predicted and actual intensive care unit length of stay was calculated. RESULTS: A total of 2955 patients were admitted during the study period. Physicians accurately predicted ICU length of stay in 1557 (52.7%) admissions. ICU length of stay was underestimated in 864 (29.2%) and overestimated in 534 (18.1%) cases. Agreement between predicted and actual intensive care unit length of stay was poor (Kappa = 0.22) and not associated with physician characteristics. Predictions of an intensive care unit length of stay of >5 days were significantly less accurate than those of <48 h and of 2-5 days (31.1, 59.8 and 53.1%, respectively, P < 0.001). CONCLUSIONS: The intensive care unit length of stay prediction in these oncological intensive care units is inaccurate and, ideally, should not be made at admission.
OBJECTIVE: To evaluate the accuracy of prediction of intensive care unit length of stay made by physicians at patient admission. DESIGN: Prospective cohort study. SETTING: Three medical-surgical intensive care units in an oncology hospital. PATIENTS: All patients admitted between January and December 2014. INTERVENTIONS: None. MAIN OUTCOME MEASUREMENTS: Intensive care unit (ICU) length of stay was estimated by the physicians responsible for patient admission and categorized as <48 h, 2-5 days or more than 5 days. Agreement between predicted and actual intensive care unit length of stay was calculated. RESULTS: A total of 2955 patients were admitted during the study period. Physicians accurately predicted ICU length of stay in 1557 (52.7%) admissions. ICU length of stay was underestimated in 864 (29.2%) and overestimated in 534 (18.1%) cases. Agreement between predicted and actual intensive care unit length of stay was poor (Kappa = 0.22) and not associated with physician characteristics. Predictions of an intensive care unit length of stay of >5 days were significantly less accurate than those of <48 h and of 2-5 days (31.1, 59.8 and 53.1%, respectively, P < 0.001). CONCLUSIONS: The intensive care unit length of stay prediction in these oncological intensive care units is inaccurate and, ideally, should not be made at admission.
Authors: Gary E Weissman; Rebecca A Hubbard; Lyle H Ungar; Michael O Harhay; Casey S Greene; Blanca E Himes; Scott D Halpern Journal: Crit Care Med Date: 2018-07 Impact factor: 7.598
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