title: Power and limitations of daily prognostications of death in the medical intensive care unit.
abstract: OBJECTIVE
  We tested the accuracy of predictions of impending death for medical intensive care unit patients, offered daily by their professional medical caretakers.
  
  
  METHODS
  For 560 medical intensive care unit patients, on each medical intensive care unit day, we asked their attending physicians, fellows, residents, and registered nurses one question: "Do you think this patient will die in the hospital or survive to be discharged?"
  
  
  RESULTS
  We obtained>6,000 predictions on 2018 medical intensive care unit patient days. Seventy-five percent of MICU patients who stayed≥4 days had discordant predictions; that is, at least one caretaker predicted survival, whereas others predicted death before discharge. Only 107 of 206 (52%) patients with a prediction of "death before discharge" actually died in hospital. This number rose to 66% (96 of 145) for patients with 1 day of corroborated (i.e., >1) prediction of "death," and to 84% (79 of 94) with at least 1 unanimous day of predictions of death. However, although positive predictive value rose with increasingly stringent prediction criteria, sensitivity fell so that the area under the receiver-operator characteristic curve did not differ for single, corroborated, or unanimous predictions of death. Subsets of older (>65 yrs) and ventilated medical intensive care unit patients revealed parallel findings.
  
  
  CONCLUSIONS
  1) Roughly half of all medical intensive care unit patients predicted to die in hospital survived to discharge nonetheless. 2) More highly corroborated predictions had better predictive value; although, approximately 15% of patients survived unexpectedly, even when predicted to die by all medical caretakers.
authors.affiliation: Department of Medicine and the MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA. WLM1@uchicago.edu
authors.forename: William
authors.initials: W
authors.lastname: Meadow
authors.forename: Anne
authors.initials: A
authors.lastname: Pohlman
authors.forename: Laura
authors.initials: L
authors.lastname: Frain
authors.forename: Yaya
authors.initials: Y
authors.lastname: Ren
authors.forename: John Paul
authors.initials: JP
authors.lastname: Kress
authors.forename: Winnie
authors.initials: W
authors.lastname: Teuteberg
authors.forename: Jesse
authors.initials: J
authors.lastname: Hall
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007396:Internship and Residency; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D028761:Withholding Treatment / Q000706:statistics & numerical data