Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study.
OBJECTIVE
To determine whether clinicians' prognoses in patients with severe acute exacerbations of obstructive lung disease admitted to intensive care match observed outcomes in terms of survival.


METHODS
Prospective cohort study.


METHODS
92 intensive care units and three respiratory high dependency units in the United Kingdom.


METHODS
832 patients aged 45 years and older with breathlessness, respiratory failure, or change in mental status because of an exacerbation of COPD, asthma, or a combination of the two.


METHODS
Outcome predicted by clinicians. Observed survival at 180 days.


RESULTS
517 patients (62%) survived to 180 days. Clinicians' prognoses were pessimistic, with a mean predicted survival of 49% at 180 days. For the fifth of patients with the poorest prognosis according to the clinician, the predicted survival rate was 10% and the actual rate was 40%. Information from a database covering 74% of intensive care units in the UK suggested no material difference between units that participated and those that did not. Patients recruited were similar to those not recruited in the same units.


CONCLUSIONS
Because decisions on whether to admit patients with COPD or asthma to intensive care for intubation depend on clinicians' prognoses, some patients who might otherwise survive are probably being denied admission because of unwarranted prognostic pessimism.
Wildman
Martin J
MJ
Northern General Hospital, Sheffield. martin.wildman@sth.nhs.uk
Sanderson
Colin
C
Groves
Jayne
J
Reeves
Barnaby C
BC
Ayres
Jon
J
Harrison
David
D
Young
Duncan
D
Rowan
Kathy
K
D000368:Aged; D001249:Asthma / Q000401:mortality* / Q000628:therapy; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D003657:Decision Making; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology