BMJ  2007;335:1225-1226 (15 December), doi:10.1136/bmj.39423.448681.1F

Letters

Prognostic pessimism

Not all bad?

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

Wildman et al touch on the issue of prognosis in critically ill patients.¹ They conclude that undue pessimism leads to unjustified refusal. What is shown, however, is that doctors, despite their pessimism, admit patients to the intensive care unit—a sign that they are aware of their limited prognostic capability.

Is the intensivist the right person to predict 180 day mortality? We usually don’t see our patients after they have been discharged from intensive care and so have little insight into the average 180 day mortality in our patient group. In our practice, the decision to admit a patient to intensive care is made jointly with the referring specialist after discussion about the patient’s short and long term prognosis. Studying this estimated prognosis would be more realistic.

The median length of stay of patients with chronic obstructive pulmonary disease (COPD) in the study is 16 days. In our intensive care unit, . . . [Full text of this article]

¹ Department of Critical Care, University Medical Centre Groningen, PO Box 30.001 9700 RB Groningen, Netherlands

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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]