The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness

Ivo W. Soliman*, Olaf L. Cremer, Dylan W. de Lange, Arjen J.C. Slooter, Johannes (Hans) J.M. van Delden, Diederik van Dijk, Linda M. Peelen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose To 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). Methods We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay > 48 h 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-3 L index < 0.4. Results Among 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. Conclusions Prognoses 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.

Original languageEnglish
Pages (from-to)148-155
Number of pages8
JournalJournal of Critical Care
Publication statusPublished - 1 Feb 2018


  • Critical care
  • Health related quality of life
  • Intensive care
  • Intuitive physician prognosis
  • Long-term outcomes
  • Subjective prognosis


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