• Ivo W Soliman, Olaf L Cremer, Dylan W de Lange, SlooterArjen J CAJCDepartment of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: A.Slooter-3@umcutrecht.nl., Johannes Hans J M van Delden, Diederik van Dijk, and Linda M Peelen.
• Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: I.W.Soliman@umcutrecht.nl.
• J Crit Care. 2018 Feb 1; 43: 148-155.

PurposeTo assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL).MethodsWe performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4.ResultsAmong 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results.ConclusionsPrognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome.Copyright © 2017 Elsevier Inc. All rights reserved.

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