To study the prognostic pessimism of physicians when triaging seriously ill patients.
A prospective cohort study in a large tertiary care teaching hospital in an urban setting in USA. A total of 1182 adult patients, from the ER, medical and surgical wards, were evaluated by the MICU on-call physicians for admission to the MICU. The on-call physicians predicted the pateints’ survival based on their evaluation of the patients at the time of making triage decission.
The main outcome measure was survival predicted by the triaging physician and observed survival at hospital discharge. Patients were divided into 5 quintiles based on their predicted survival. The average predicted survival for each quintile was compared to the observed survival. The mean (95% CI) predicted survival for each quintile of was: 52% (50–54%), 79% (78–79%), 89% (88–89%), 95% (94–95%), and 98% (98–99%). The respective observed survival for each quintile was: 76%, 85%, 96%, 98%, and 97%.
Critical care physicians underestimate survival of the sicker patients considered for admission to the MICU. They are generally pessimistic regarding prognosis when triaging seriously ill patients.
The study helps to better understand the process of decission making when triaging very sick patients. The prognostic pessimism of the triaging physician may lead them to make unnecessary admissions to the MICU.
Rina Awan, No Financial Disclosure Information; No Product/Research Disclosure Information