Profiles of neurological outcome prediction among intensivists.
Profiles of neurological outcome prediction among intensivists.
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DOI：
10.1007/s12028-009-9225-9
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发表时间：
2009-12
影响因子：
3.5
通讯作者：
Lansberg, Maarten G.
中科院分区：
文献类型：
--
作者：
Racine, Eric;Dion, Marie-Josee;Wijman, Christine A. C.;Illes, Judy;Lansberg, Maarten G.
重症监护医学的进步提高了神经危重患者的存活率。因此，对这类患者的预测重点正从预测生存机会转向有意义的神经康复。这项研究评估了医生在长期结果预测中的可变性，并旨在确定可能解释这种可变性的因素。根据描述一名患有缺氧后脑损伤的昏迷患者的临床片段，强化医生在半结构化访谈中被问及患者特定的神经预后和一般预测。定性研究方法被用来确定预测中的可变性区域，并根据特定的预测概况对医生进行分类。定量统计被用来评估预测特征与医生的人口统计和执业特征之间的关联。18名集约主义者参加了会议。功能性结果预测在评估维度(一般/好-差)和信心维度(确定-不确定)上各不相同。更有经验的医生往往对患者的功能结果更悲观，对他们的预后更确定。对生活质量的态度在评价维度(好-差)和“风格”维度(客观-主观)上各不相同。与年轻和缺乏经验的医生相比，年长和经验丰富的医生更有可能表达对生活质量的客观判断，并预测患者的生活质量更差。强化论者之间存在着不同的预测特征。这可能是由医生的年龄和临床经验等因素决定的。意识到这些关联可能是更一致的预测的第一步。
Advances in intensive care medicine have increased survival rates of patients with critical neurological conditions. The focus of prognostication for such patients is therefore shifting from predicting chances of survival to meaningful neurological recovery. This study assessed the variability in long-term outcome predictions among physicians and aimed to identify factors that may account for this variability. Based on a clinical vignette describing a comatose patient suffering from post-anoxic brain injury intensivists were asked in a semi-structured interview about the patient’s specific neurological prognosis and about prognostication in general. Qualitative research methods were used to identify areas of variability in prognostication and to classify physicians according to specific prognostication profiles. Quantitative statistics were used to assess for associations between prognostication profiles and physicians’ demographic and practice characteristics. Eighteen intensivists participated. Functional outcome predictions varied along an evaluative dimension (fair/good–poor) and a confidence dimension (certain–uncertain). More experienced physicians tended to be more pessimistic about the patient’s functional outcome and more certain of their prognosis. Attitudes toward quality of life varied along an evaluative dimension (good–poor) and a “style” dimension (objective–subjective). Older and more experienced physicians were more likely to express objective judgments of quality of life and to predict a worse quality of life for the patient than their younger and less experienced counterparts. Various prognostication profiles exist among intensivists. These may be dictated by factors such as physicians’ age and clinical experience. Awareness of these associations may be a first step to more uniform prognostication.
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