title: Can the experienced ICU physician predict ICU length of stay and outcome better than less experienced colleagues?
abstract: OBJECTIVE
  To assess the ability of physicians with varying degrees of experience to predict the length of stay and outcome of intensive care unit (ICU) patients.
  
  
  METHODS
  Prospective, interview-based study.
  
  
  METHODS
  A 31-bed mixed medical-surgical ICU.
  
  
  METHODS
  A total of 223 consecutive patients (excluding those admitted for routine post-operative surveillance) admitted to the ICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  Physicians immediately responsible for each patient, and others fully aware of the case, were interviewed separately during the first 12 h of ICU admission to determine their assessment of the patient's likely duration of stay on the ICU and the probable outcome. Degree of predictive accuracy was assessed using the Kappa statistic with kappa < or =0.2 poor, 0.21-0.4 fair, 0.41-0.60 moderate, 0.61-0.8 good, and 0.81-1.0 very good. Physicians were graded according to their degree of experience as junior (less than 1 year ICU experience), medium (critical care fellow), and senior (staff physician with supervising functions). For lengths of stay less than 5 days, senior physicians were better predictors than less experienced doctors. For outcome prediction, physicians were generally moderately good at predicting death, with senior physicians tending to be more accurate than their less experienced colleagues (senior kappa 0.68, medium kappa 0.52, junior kappa 0.43).
  
  
  CONCLUSIONS
  Prediction of length of ICU stay was poor amongst all physicians in patients with a length of stay greater than 5 days. Experienced physicians were better predictors of ICU lengths of stay less than 5 days and, in contrast to some reports, of ICU outcome than their more inexperienced counterparts.
authors.affiliation: :Department of Intensive Care Unit, Erasme Hospital Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Fábio
authors.initials: F
authors.lastname: Gusmão Vicente
authors.forename: Frederico
authors.initials: F
authors.lastname: Polito Lomar
authors.forename: Christian
authors.initials: C
authors.lastname: Mélot
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000145:classification / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors