Identification of futility in intensive care.
Rising costs of intensive care and the ability to prolong the life of critically ill patients creates a need to recognise early those patients who will die despite treatment.
We used changes in a modified APACHE II score (organ failure score) to make daily predictions of individual outcome in 3600 patients. 137 patients were predicted to die and of these, 131 (95.6%) died within 90 days of discharge from hospital (sensitivity 23.4%, specificity 99.8%) ; a false-positive diagnosis rate of 4.4%. 2 of the 6 survivors have subsequently died but 4 are alive with good quality of life.
Patients predicted to die stayed 1492 days in intensive care and incurred 16.7% of total intensive care expenditure and 46.4% of the cost of all patients that died.
Mots-clés Pascal : Traitement, Soin intensif, Indication, Politique sanitaire, Analyse avantage coût, Homme
Mots-clés Pascal anglais : Treatment, Intensive care, Indication, Health policy, Cost benefit analysis, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0024070
Code Inist : 002B30A01C. Création : 09/06/1995.