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Published on: August 1, 2019
Prognosis in the intensive care unit: finding accurate and useful estimates for counseling patients
A G Randolph1, G H Guyatt, W S Richardson
1Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, ON, Canada.
Insights
Clinicians need to critically appraise prognostic studies for critically ill patients. Ensuring representative, homogeneous samples and sufficient follow-up improves the accuracy of prognostic information for patient counseling.
Area of Science:
- Medical research methodology
- Clinical epidemiology
- Prognostic study appraisal
Background:
- Accurate prognostic information is crucial for counseling critically ill patients and their families.
- Clinicians require skills to find and evaluate prognostic studies.
Observation:
- Prognostic studies examining homogeneous patient populations were reviewed.
- A clinical example involving children in a persistent vegetative state was considered.
Findings:
- Study validity is enhanced by representative and homogeneous patient samples.
- Sufficient follow-up and objective outcome evaluation are critical for reliable prognostic studies.
- Understandable presentation of outcome likelihoods and probability estimates is essential.
Implications:
- Clinicians can use established criteria to interpret prognostic studies for patient counseling.
- Ensuring patient and management similarity between studies and clinical practice is vital.
- Proper appraisal of prognostic research supports informed clinical decision-making.
Objectives:
Counseling critically ill patients and their families about what the future is likely to hold requires accurate prognostic information. Our goal is to teach clinicians how to find and critically appraise prognostic studies that examine homogeneous populations. CLINICAL EXAMPLE: An article describing the outcomes of a group of children who are in a prolonged, persistent vegetative state.
Recommendations:
The validity of prognostic studies is increased when: a) the sample of patients is representative; b) patients are homogeneous with respect to prognostic risk; c) follow-up is sufficient to minimize the possibility that the missing patients could alter the interpretation of the results; and d) health outcomes are evaluated, using objective and unbiased criteria. The likelihood of these outcomes over time and the precision around these probability estimates should be easily understandable. Before using the results of these studies to counsel patients and families, practitioners should ensure that the patients in the study and their management are similar to the patient in question, and that follow-up of the subjects is sufficiently long.
Conclusions:
The criteria outlined in this article may assist clinicians in interpreting articles describing the prognosis of patients with similar clinical conditions.
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