title: The Perceived Likelihood of Outcome of Critical Care Patients and Its Impact on Triage Decisions: A Case-Based Survey of Intensivists and Internists in a Canadian, Quaternary Care Hospital Network.
abstract: BACKGROUND
  There is high variability amongst physicians' assessments of appropriate ICU admissions, which may be based on potential assessments of benefit. We aimed to examine whether opinions over benefit of ICU admissions of critically ill medical inpatients differed based on physician specialty, namely intensivists and internists.
  
  
  METHODS
  We carried out an anonymous, web-based questionnaire survey containing 5 typical ICU cases to all ICU physicians regardless of their base specialty as well as to all internists in 3 large teaching hospitals. For each case, we asked the participants to determine if the patient was an appropriate ICU admission and to assess different parameters (e.g. baseline function, likelihood of survival to ICU discharge, etc.). Agreement was measured using kappa values.
  
  
  RESULTS
  21 intensivists and 22 internists filled out the survey (response rate = 87.5% and 35% respectively). Predictions of likelihood of survival to ICU admission, hospital discharge and return to baseline were not significantly different between the two groups. However, agreement between individuals within each group was only slight to fair (kappa range = 0.09-0.22). There was no statistically significant difference in predicting ICU survival and prediction of survival to hospital discharge between both groups. The accuracy with which physicians predicted actual outcomes ranged between 35% and 100% and did not significantly differ between the two groups. A greater proportion of internists favoured non resuscitative measures (24.6% of intensivists and 46.9% internists [p = 0.002]).
  
  
  CONCLUSIONS
  In a case-based survey, physician specialty base did not affect assessments of ICU admission benefit or accuracy in outcome prediction, but resulted in a statistically significant difference in level of care assignments. Of note, significant disagreement amongst individuals in each group was found.
authors.affiliation: Department of Critical Care, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Dahine
authors.affiliation: Department of Critical Care, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Louay
authors.initials: L
authors.lastname: Mardini
authors.affiliation: Department of Critical Care, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.|Department of General Internal Medicine, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.|Department of Critical Care, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Dev
authors.initials: D
authors.lastname: Jayaraman
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D000066491:Clinical Decision-Making / Q000379:methods; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010820:Physicians; D016019:Survival Analysis; D016896:Treatment Outcome; D014218:Triage / Q000379:methods