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ICU physicians are unable to accurately predict length of stay at admission: a prospective study
Antonio Paulo Nassar1, Pedro Caruso2
1Intensive Care Unit, AC Camargo Cancer Center, São Paulo-SP, Brazil Discipline of Medical Emergencies, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Objective:
To evaluate the accuracy of prediction of intensive care unit length of stay made by physicians at patient admission.
Design:
Prospective cohort study.
Setting:
Three medical-surgical intensive care units in an oncology hospital.
Patients:
All patients admitted between January and December 2014.
Interventions:
None.
Main Outcome Measurements:
Intensive care unit (ICU) length of stay was estimated by the physicians responsible for patient admission and categorized as <48 h, 2-5 days or more than 5 days. Agreement between predicted and actual intensive care unit length of stay was calculated.
Results:
A total of 2955 patients were admitted during the study period. Physicians accurately predicted ICU length of stay in 1557 (52.7%) admissions. ICU length of stay was underestimated in 864 (29.2%) and overestimated in 534 (18.1%) cases. Agreement between predicted and actual intensive care unit length of stay was poor (Kappa = 0.22) and not associated with physician characteristics. Predictions of an intensive care unit length of stay of >5 days were significantly less accurate than those of <48 h and of 2-5 days (31.1, 59.8 and 53.1%, respectively, P < 0.001).
Conclusions:
The intensive care unit length of stay prediction in these oncological intensive care units is inaccurate and, ideally, should not be made at admission.
