1. The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality
- Author
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Eline G M Cox, Willem Dieperink, Iwan C. C. van der Horst, Madelon E Vos, Renske Wiersema, Wolter Paans, Marisa Onrust, Jacqueline Koeze, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Cardiovascular Centre (CVC), Intensive Care, MUMC+: MA Intensive Care (3), MUMC+: MA Medische Staf IC (9), RS: Carim - V04 Surgical intervention, Nursing Diagnostics, and Earthquake Resistant Structures & Promising Groningen
- Subjects
medicine.medical_specialty ,Students, Medical ,Critical Care ,Critical Illness ,PREDICTIONS ,Nurses ,INTENSIVE-CARE ,DECISION-MAKING ,Nursing Staff, Hospital ,ernstig zieke patiënten ,Critical Care and Intensive Care Medicine ,Logistic regression ,Prognostic ,CLINICAL JUDGMENT ,PATIENT ,law.invention ,Odds ,Critically ill patients ,law ,Multidisciplinary approach ,Physicians ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Students ,Hospitals, Teaching ,Netherlands ,OUTCOMES ,Receiver operating characteristic ,business.industry ,Critically ill ,RC86-88.9 ,Research ,Mortality rate ,Estimations ,Reproducibility of Results ,Medical emergencies. Critical care. Intensive care. First aid ,Prognosis ,Intensive care unit ,prognose ,kritieke zorg ,Mortality prediction ,UNIT ,Emergency medicine ,prognostic assessment ,Observational study ,Students, Nursing ,business - Abstract
Background Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students’, nurses’, and physicians’ estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up. Methods The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians. Results In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed. Conclusions Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.
- Published
- 2021