Document Detail


Can the experienced ICU physician predict ICU length of stay and outcome better than less experienced colleagues?
MedLine Citation:
PMID:  14735235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. DESIGN: Prospective, interview-based study. SETTING: A 31-bed mixed medical-surgical ICU. PATIENTS: A total of 223 consecutive patients (excluding those admitted for routine post-operative surveillance) admitted to the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN 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:
Fábio Gusmão Vicente; Frederico Polito Lomar; Christian Mélot; Jean-Louis Vincent
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Publication Detail:
Type:  Journal Article     Date:  2004-01-21
Journal Detail:
Title:  Intensive care medicine     Volume:  30     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-31     Completed Date:  2004-10-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  655-9     Citation Subset:  IM    
Affiliation:
:Department of Intensive Care Unit, Erasme Hospital Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Clinical Competence / standards
Female
Humans
Intensive Care
Intensive Care Units*
Length of Stay
Male
Middle Aged
Physicians / classification,  standards*
Prognosis
Prospective Studies
Questionnaires
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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