title: Power and limitations of daily prognostications of death in the medical ICU for outcomes in the following 6 months.
abstract: OBJECTIVE
  We tested the power of clinicians' predictions that a medical ICU patient would "die before hospital discharge" for both survival to discharge and for outcomes at 6 months.
  
  
  METHODS
  We restricted our analyses to patients who had been in the medical ICU at least 72 hours and for whom we had follow-up at 6 months after medical ICU admission. For 350 medical ICU patients, on each medical ICU day, we asked their attending physician, fellow, resident, and primary nurse one question-"do you think this patient will die in hospital or survive to be discharged"? We correlated these responses with 6-month outcomes (death and/or Barthel score for survivors).
  
  
  RESULTS
  We obtained over 6,000 predictions on 2,271 medical ICU patient-days. Of 350 medical ICU patients who stayed more than 72 hours, 143 patients (41%) had discordant predictions-that is, on the same medical ICU day, at least one provider predicted survival, whereas another predicted death before discharge. As we have shown previously, predictions of "death before discharge" were imperfect-only 104 of 187 of patients with a prediction of death (56%) actually died in hospital. However, this is the central finding of our study, and predictions of death before discharge were much more accurate for 6-month outcomes. Of 120 patients with a corroborated prediction of death before discharge (93%), 112 patients had died within 6 months of medical ICU discharge, and only 4% were functioning with a Barthel score more than 70. In contrast, 67 of 163 patients who did not have any prediction of death before discharge (41%) were alive with Barthel score more than 70 at 6 months.
  
  
  CONCLUSIONS
  Fewer than 4% of medical ICU patients who required 72 hours of medical ICU care and had a corroborated prediction of death before discharge were alive at 6 months and functioning with a Barthel score more than 70.
authors: Departments of Medicine and Pediatrics, and the MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL.
authors: William
authors: W
authors: Meadow
authors: Anne
authors: A
authors: Pohlman
authors: Dan
authors: D
authors: Reynolds
authors: Leah
authors: L
authors: Rand
authors: Camil
authors: C
authors: Correia
authors: Ella
authors: E
authors: Christoph
authors: Jesse
authors: J
authors: Hall
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D002641:Chicago; D015331:Cohort Studies; D003643:Death; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors