Anne Radtke1, Roman Pfister2, Kathrin Kuhr3, Matthias Kochanek4, Guido Michels5. 1. Department III of Internal Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: anne.radtke@uk-koeln.de. 2. Department III of Internal Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: roman.pfister@uk-koeln.de. 3. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: kathrin.kuhr@uni-koeln.de. 4. Department I of Internal Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: matthias.kochanek@uk-koeln.de. 5. Department III of Internal Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: guido.michels@uk-koeln.de.
Abstract
PURPOSE: The aim of the FEELING-ON-ICU study was to compare mortality estimations of critically ill patients based on 'gut feeling' of medical staff and by Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS: Medical staff estimated patients' mortality risks via questionnaires. APACHE II, SAPS II and SOFA were calculated retrospectively from records. Estimations were compared with actual in-hospital mortality using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). RESULTS: 66 critically ill patients (60.6% male, mean age 63±15years (range 30-86)) were evaluated each by a nurse (n=66, male 32.4%) and a physician (n=66, male 67.6%). 15 (22.7%) patients died on the intensive care unit. AUC was largest for estimations by physicians (AUC 0.814 (95% CI 0.705-0.923)), followed by SOFA (AUC 0.749 (95% CI 0.629-0.868)), SAPS II (AUC 0.723 (95% CI 0.597-0.849)), APACHE II (AUC 0.721 (95% CI 0.595-0.847)) and nursing staff (AUC 0.669 (95% CI 0.529-0.810)) (p<0.05 for all results). CONCLUSIONS: The concept of physicians' 'gut feeling' was comparable to classical objective scores in mortality estimations of critically ill patients. Concerning practicability physicians' evaluations were advantageous to complex score calculation.
PURPOSE: The aim of the FEELING-ON-ICU study was to compare mortality estimations of critically illpatients based on 'gut feeling' of medical staff and by Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS: Medical staff estimated patients' mortality risks via questionnaires. APACHE II, SAPS II and SOFA were calculated retrospectively from records. Estimations were compared with actual in-hospital mortality using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). RESULTS: 66 critically illpatients (60.6% male, mean age 63±15years (range 30-86)) were evaluated each by a nurse (n=66, male 32.4%) and a physician (n=66, male 67.6%). 15 (22.7%) patients died on the intensive care unit. AUC was largest for estimations by physicians (AUC 0.814 (95% CI 0.705-0.923)), followed by SOFA (AUC 0.749 (95% CI 0.629-0.868)), SAPS II (AUC 0.723 (95% CI 0.597-0.849)), APACHE II (AUC 0.721 (95% CI 0.595-0.847)) and nursing staff (AUC 0.669 (95% CI 0.529-0.810)) (p<0.05 for all results). CONCLUSIONS: The concept of physicians' 'gut feeling' was comparable to classical objective scores in mortality estimations of critically illpatients. Concerning practicability physicians' evaluations were advantageous to complex score calculation.
Authors: Eline G M Cox; Marisa Onrust; Madelon E Vos; Wolter Paans; Willem Dieperink; Jacqueline Koeze; Iwan C C van der Horst; Renske Wiersema Journal: Crit Care Date: 2021-11-15 Impact factor: 9.097