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HOW WELL DO PHYSICIANS ESTIMATE MORTALITY AT DISCHARGE FROM ICU?

HOW WELL DO PHYSICIANS ESTIMATE MORTALITY AT DISCHARGE FROM ICU?. Dr Sam Ley CT2 ICM Dr Radha Sundaram Consultant ICM Royal Alexandra Hospital, Paisley, Scotland. INTRODUCTION.

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HOW WELL DO PHYSICIANS ESTIMATE MORTALITY AT DISCHARGE FROM ICU?

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  1. HOW WELL DO PHYSICIANS ESTIMATE MORTALITY AT DISCHARGE FROM ICU? Dr Sam Ley CT2 ICM Dr Radha Sundaram Consultant ICM Royal Alexandra Hospital, Paisley, Scotland

  2. INTRODUCTION There are a variety of prognostic scoring systems used within ICM, however studies have shown clinician’s prediction of outcome is more powerful than a single APACHE II score at admission [1] [2]. This study asks the question: Does physician’s prediction of patient outcome at ICU discharge correlate with the 30 day mortality in all patients discharged from a seven bedded ICU (400 admissions a year) in a UK District General Hospital? • Rocker GM, Cook D Et al. Clinicians prediction of ICU mortality. Critical Care Medicine.2004;32;5; 1149 -1154. • Scholz N, Basler K et al. Outcome prediction in critical care: physicians prognoses versus scoring systems. EJA. 2004.21(8) ;606-611.

  3. METHOD A retrospective database study was conducted of all patients discharged in a one year period (2011) from the ICU. Date was collected on: • Age, gender, admitting specialty. • APACHE II, physician prediction of outcome. • Survival at discharge and at 30 days.

  4. RESULTS

  5. RESULTS • Prediction of “Survivor/Non-Survivor” showed: • Statistical significance with 30 day mortality (p<0.0001). • PPV 98.3%, NPV 100%. • Patients given an “Uncertain” outcome had a 30 day survival of 82%. • The was a statistically significant relationship between 30 day mortality and APACHE II (p<0.0001).

  6. CONCLUSION • The physician’s opinion with regards to whether a patient would be a “Survivor” or a “Non Survivor” at discharge was a statistically significant predictor of 30 day mortality post discharge within this ICU. • Patients with a “Uncertain” outcome tended towards 30 day survival.

  7. LIMITATIONS & DEVELOPMENT • Limitations included the studies retrospective nature, the reliance on data sources and that the primary outcome was mortality and not quality of life. • Further studies are needed to evaluate quality of life predictions, as this would alter clinical decision making to a greater extent than mortality predictions.

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