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. 1. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: I.W.Soliman@umcutrecht.nl. 2. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: O.L.Cremer@umcutrecht.nl. 3. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: D.W.deLange@umcutrecht.nl. 4. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: A.Slooter-3@umcutrecht.nl. 5. Department of Medical Humanities, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: J.J.M.vanDelden@umcutrecht.nl. 6. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: D.vanDijk@umcutrecht.nl. 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: L.M.Peelen@umcutrecht.nl.
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.
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.
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