Certainty and mortality prediction in critically ill children
Certainty and mortality prediction in critically ill children
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DOI：
10.1136/jme.2002.001537
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发表时间：
2004-06-01
影响因子：
4.1
通讯作者：
Ruttimann, U. E.
中科院分区：
文献类型：
--
作者：
Marcin, J. P.;Pretzlaff, R. K.;Ruttimann, U. E.
目的：本研究的目的是调查医生的主观死亡率预测与预测结果的置信度之间的关系。设计和参与者：这项研究是在一所大学儿童医院的三级儿科重症监护病房(ICU)住院的年龄小于18岁的患者的前瞻性队列研究。儿科ICU主治医生和研究员提供死亡风险预测，以及在儿科ICU入院后24小时内连续查房时与这些预测相关的置信度水平。结果：在713名符合条件的患者中收集了642名患者的数据(36例死亡，5.6%)。高于5%和低于95%的死亡率预测的置信度明显低于95%的预测。结论：我们得出结论：医生的主观死亡率预测可能依赖于对预后的信心水平；也就是说，对自己的预后缺乏信心的医生更有可能做出中间的生存预测。因此，衡量与死亡风险预测(或任何预后评估)相关的置信度可能很重要，因为不同的置信度可能会转化为医生治疗计划和他们对患者未来的评估的不同。
Objectives: The objective of this study is to investigate the relationship between a physician's subjective mortality prediction and the level of confidence with which that mortality prediction is made.Design and participants: The study is a prospective cohort of patients less than 18 years of age admitted to a tertiary Paediatric Intensive Care Unit (ICU) at a University Children's Hospital with a minimum length of ICU stay of 10 h. Paediatric ICU attending physicians and fellows provided mortality risk predictions and the level of confidence associated with these predictions on consecutive patients at the time of multidisciplinary rounds within 24 hours of admission to the paediatric ICU. Median confidence levels were compared across different ranges of mortality risk predictions.Results: Data were collected on 642 of 713 eligible patients ( 36 deaths, 5.6%). Mortality predictions greater than 5% and less than 95% were made with significantly less confidence than those predictions 95%. Experience was associated with greater confidence in prognostication.Conclusions: We conclude that a physician's subjective mortality prediction may be dependent on the level of confidence in the prognosis; that is, a physician less confident in his or her prognosis is more likely to state an intermediate survival prediction. Measuring the level of confidence associated with mortality risk predictions ( or any prognostic assessment) may therefore be important because different levels of confidence may translate into differences in a physician's therapeutic plans and their assessment of the patient's future.