Yaya Ren

Power and limitations of daily prognostications of death in the medical intensive care unit.

Objective:We tested the accuracy of predictions of impending death for medical intensive care unit patients, offered daily by their professional medical caretakers. Design:For 560 medical intensive care unit patients, on each medical intensive care unit day, we asked their attending physicians, fellows, residents, and registered nurses one question: “Do you think this patient will die in the hospital or survive to be discharged?” Results:We obtained >6,000 predictions on 2018 medical intensive care unit patient days. Seventy-five percent of MICU patients who stayed ≥4 days had discordant predictions; that is, at least one caretaker predicted survival, whereas others predicted death before discharge. Only 107 of 206 (52%) patients with a prediction of “death before discharge” actually died in hospital. This number rose to 66% (96 of 145) for patients with 1 day of corroborated (i.e., >1) prediction of “death,” and to 84% (79 of 94) with at least 1 unanimous day of predictions of death. However, although positive predictive value rose with increasingly stringent prediction criteria, sensitivity fell so that the area under the receiver-operator characteristic curve did not differ for single, corroborated, or unanimous predictions of death. Subsets of older (>65 yrs) and ventilated medical intensive care unit patients revealed parallel findings. Conclusions:1) Roughly half of all medical intensive care unit patients predicted to die in hospital survived to discharge nonetheless. 2) More highly corroborated predictions had better predictive value; although, approximately 15% of patients survived unexpectedly, even when predicted to die by all medical caretakers.

Certainty, Uncertainty, and Accuracy of Daily Predictions of Non-Survival in the NICU: We're Often Wrong but Rarely in Doubt |[diams]| 156

Care provided in the neonatal intensive care unit (NICU) is expensive and agonizing. In order to optimize parental decisions to provide or forego medical interventions, physicians and nurses are obliged to offer their best estimates of the likelihood of survival for the infants in their care. But how good are these estimates?

Medical caretakers assessments of futility in the NICU: Does anybody really know what time it is? |[bull]| 156

No medical professional is ethically obligated to provide futile care. However, to be useful futility must be recognized prospectively; that is, in advance of the impending demise of the patient as opposed to after the fact. We wondered what percentage of futile care in the NICU (defined as care devoted to infants who would die before discharge) was recognized to be futile at the time.

What Do Clinical Intuitions of Non-Survival Add to the Predictive Power of Algorithmic Assessments of Illness-Severity in the NICU? It Depends on When You Ask

What Do Clinical Intuitions of Non-Survival Add to the Predictive Power of Algorithmic Assessments of Illness-Severity in the NICU? It Depends on When You Ask

Usefulness of Serial Algorithms of Illness Severity as a Proxy for Impending Death in the NICU: Not Much ♦ 157

Usefulness of Serial Algorithms of Illness Severity as a Proxy for Impending Death in the NICU: Not Much ♦ 157

Outcome of NICU Survivors Predicted to Die or Have Severe Neurologic Morbidity After Discharge |[bull]| 1324

NICU care is expensive, and outcomes for survivors may be less than might be hoped for. Permanent neurologic disability is a serious burden, and surrogate decision-makers may wish to consider this possibility in the benefit/burden calculations they face anew each day. We wondered how accurate medical caretakers were in their daily predictions of residual neurologic disability for NICU patients.

Survival vs FiO2 after Day of Life (DOL) 3: Are illness severity assessments ethically relevant in the NICU? ♦ 1159

Survival vs FiO2 after Day of Life (DOL) 3: Are illness severity assessments ethically relevant in the NICU? ♦ 1159

Decisions about delivery-room resuscitation for extremely premature infants: Whatever happened to baby autonomy? • 157

Decisions about delivery-room resuscitation for extremely premature infants: Whatever happened to baby autonomy? • 157