Clinician predictions of intensive care unit mortality

Title

Clinician predictions of intensive care unit mortality

Creator

Rocker G; Cook D; Sjokvist P; Weaver B; Finfer S; McDonald E; Marshall J; Kirby A; Levy M; Dodek P; Heyland D; Guyatt G; Level of Care Study Investigators; Canadian Critical Care Trials Group

Publisher

Critical Care Medicine

Date

2004

Subject

Female; Humans; Male; Medical Staff; Hospital Mortality; Prognosis; Prospective Studies; Middle Aged; Respiration; Severity of Illness Index; Survival Analysis; Risk Factors; Predictive Value of Tests; Chi-Square Distribution; Proportional Hazards Models; Nursing Staff; Artificial; Intensive Care Units/statistics & numerical data; APACHE; Nursing Assessment/standards; Likelihood Functions; Clinical Competence/standards; Critical Illness/mortality/therapy; Hospital/standards; Multiple Organ Failure/classification/mortality

Description

OBJECTIVE: Predicting outcomes for critically ill patients is an important aspect of discussions with families in the intensive care unit. Our objective was to evaluate clinical intensive care unit survival predictions and their consequences for mechanically ventilated patients. DESIGN: Prospective cohort study. SETTING: Fifteen tertiary care centers. PATIENTS: Consecutive mechanically ventilated patients > or = 18 yrs of age with expected intensive care unit stay > or = 72 hrs. INTERVENTIONS: We recorded baseline characteristics at intensive care unit admission. Daily we measured multiple organ dysfunction score (MODS), use of advanced life support, patient preferences for life support, and intensivist and bedside intensive care unit nurse estimated probability of intensive care unit survival. MEASUREMENTS AND MAIN RESULTS: The 851 patients were aged 61.2 (+/- 17.6, mean + SD) yrs with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 21.7 (+/- 8.6). Three hundred and four patients (35.7%) died in the intensive care unit, and 341 (40.1%) were assessed by a physician at least once to have a < 10% intensive care unit survival probability. Independent predictors of intensive care unit mortality were baseline APACHE II score (hazard ratio, 1.16; 95% confidence interval, 1.08-1.24, for a 5-point increase) and daily factors such as MODS (hazard ratio, 2.50; 95% confidence interval, 2.06-3.04, for a 5-point increase), use of inotropes or vasopressors (hazard ratio, 2.14; 95% confidence interval, 1.66-2.77), dialysis (hazard ratio, 0.51; 95% confidence interval, 0.35-0.75), patient preference to limit life support (hazard ratio, 10.22; 95% confidence interval, 7.38-14.16), and physician but not nurse prediction of < 10% survival. The impact of physician estimates of < 10% intensive care unit survival was greater for patients without vs. those with preferences to limit life support (p < .001) and for patients with less vs. more severe organ dysfunction (p < .001). Mechanical ventilation, inotropes or vasopressors, and dialysis were withdrawn more often when physicians predicted < 10% probability of intensive care unit survival (all ps < .001). CONCLUSIONS: Physician estimates of intensive care unit survival < 10% are associated with subsequent life support limitation and more powerfully predict intensive care unit mortality than illness severity, evolving or resolving organ dysfunction, and use of inotropes or vasopressors.
2004

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

1149-1154

Issue

5

Volume

32

Citation

Rocker G; Cook D; Sjokvist P; Weaver B; Finfer S; McDonald E; Marshall J; Kirby A; Levy M; Dodek P; Heyland D; Guyatt G; Level of Care Study Investigators; Canadian Critical Care Trials Group, “Clinician predictions of intensive care unit mortality,” Pediatric Palliative Care Library, accessed August 3, 2021, https://pedpalascnetlibrary.omeka.net/items/show/12812.

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