• Pierre-Marie Bertrand, Bruno Pereira, Mireille Adda, Jean-François Timsit, Michel Wolff, Gilles Hilbert, Didier Gruson, Maïté Garrouste-Orgeas, Laurent Argaud, Jean-Michel Constantin, Russel Chabanne, Quenot Jean-Pierre JP Intensive Care Unit, Bocage Central Hospital, University Hospital of Dijon, Dijon, France., Julien Bohe, Claude Guerin, Laurent Papazian, Olivier Jonquet, Kada Klouche, Arnaud Delahaye, Beatrice Riu, Laurent Zieleskiewicz, Michaël Darmon, Elie Azoulay, Bertrand Souweine, and Alexandre Lautrette.
• Intensive Care Unit, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
• Crit. Care Med. 2019 Mar 1; 47 (3): 337-344.

ObjectivesTo compare the assessment of decision-making capacity of ICU patients by attending clinicians (physicians, nurses, and residents) with a capacity score measured by the Mini-Mental Status Examination, completed by Aid to Capacity Evaluation if necessary. The primary outcome was agreement between physicians' assessments and the score. Secondary outcomes were agreement between nurses' or residents' assessments and the score and identification of factors associated with disagreement.DesignA 1-day prevalence study.SettingNineteen ICUs in France.SubjectsAll patients hospitalized in the ICU on the study day and the attending clinicians.InterventionsThe decision-making capacity of patients was assessed by the attending clinicians and independently by an observer using the score.Measurements And Main ResultsA total of 206 patients were assessed by 213 attending clinicians (57 physicians, 97 nurses, and 59 residents). Physicians designated more patients as having decision-making capacity (n = 92/206 [45%]) than score (n = 34/206 [17%]; absolute difference 28% [95% CI, 20-37%]; p = 0.001). There was a high disagreement between assessments of all clinicians and score (Kappa coefficient 0.39 [95% CI, 0.29-0.50] for physicians; 0.39 [95% CI, 0.27-0.52] for nurses; and 0.46 [95% CI, 0.35-0.58] for residents). The main factor associated with disagreement was a Glasgow Coma Scale score between 10 and 15 (odds ratio, 2.92 [1.18-7.19], p = 0.02 for physicians; 4.97 [1.50-16.45], p = 0.01 for nurses; and 3.39 [1.12-10.29], p = 0.03 for residents) without differentiating between the Glasgow Coma Scale scores from 10 to 15.ConclusionsThe decision-making capacity of ICU patients was largely overestimated by all attending clinicians as compared with a score. The main factor associated with disagreement was a Glasgow Coma Scale score between 10 and 15, suggesting that clinicians confused consciousness with decision-making capacity.

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