BMJ  2007;335:1103-1104 (1 December), doi:10.1136/bmj.39378.654329.80 (published 1 November 2007)

Editorials

Deciding who to admit to a critical care unit

Scarce resources may cause doctors to be pessimistic about prognosis and refuse critical care admissions

The first 150 words of the full text of this article appear below.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The incidence of COPD is rising, and the World Health Organization estimates that it will be the fourth leading cause of death globally by 2030.¹ In this week's BMJ, Wildman and colleagues report the differences between actual survival and survival predicted by a doctor in people with asthma or COPD admitted to intensive care.² This is an important matter to investigate, because people with asthma and COPD who have acute exacerbations that require admission to intensive care have high short term mortality.^{3 4}

Using data from 832 admissions for asthma or COPD in 95 intensive care units and high dependency units in the United Kingdom, the authors found that predicted survival was lower than actual survival (49% v 62%) 180 days after admission. This "prognostic pessimism" was present in the overall sample and for most subgroups . . . [Full text of this article]

Johns Hopkins Medical Institutions, Division of Pulmonary and Critical Care Medicine, Baltimore, MD 21205, USA

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Related Article

Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study

Martin J Wildman, Colin Sanderson, Jayne Groves, Barnaby C Reeves, Jon Ayres, David Harrison, Duncan Young, and Kathy Rowan
BMJ 2007 335: 1132. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• (2007). Predicting Which Patients with Respiratory Distress Will Survive. JWatch Emergency Med. 2007: 4-4 [Full text]  

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Who / Whom

Thomas Szasz
bmj.com, 30 Nov 2007 [Full text]

Re: Who / Whom

Neville W Goodman
bmj.com, 5 Dec 2007 [Full text]