Pessimistic docs may keep patients from ICU

Last Updated: 2007-11-02 10:02:46 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Doctors tend to underestimate the probability that patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) or asthma will survive, and as a result, many patients may be inappropriately denied admission to the intensive care unit (ICU), investigators report in BMJ Online First for November 2.

COPD causes about 30,000 deaths each year in the UK and many patients who suffer attacks of COPD can benefit from assisted ventilation, but they have to be admitted to the ICU to receive this treatment.

British researchers studied results from 92 ICUs and three respiratory units in the UK that dealt with 832 patients aged 45 years and older treated in the units because of worsening COPD or asthma.

On admission, the admitting doctor was asked to estimate the patient's likelihood of surviving to discharge and up to 180 days after admission.

Overall, 62 percent of patients survived to 180 days after the incident, but doctors predicted an average survival rate of just 49 percent, Dr. Martin J. Wildman of Northern General Hospital, Sheffield, and associates found.

For the fifth of patients with the poorest prognosis according to the doctors, the predicted survival rate was 10 percent but the actual survival rate was 40 percent.

"Clinicians are generally pessimistic about the survival of patients with exacerbations of COPD and have particular problems in identifying those with poor prognosis," the researchers write. "Patients might therefore be inappropriately excluded from intensive care and the change of intubation on the basis of a false prediction of futility."

The scarcity of intensive care resources in the UK may explain the study findings, two US researchers note in a commentary. A lack of intensive care beds, Dr. Eddy Fan and Dr. Dale M. Needham at Johns Hopkins in Baltimore suggest, may lead to pessimistic predictions of survival, because it may stop doctors feeling they're denying patients potentially life-saving treatment for lack of resources.

SOURCE: BMJ Online First November 2, 2007.