You searched for:"Lucas Lonardoni Crozatti"
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Original Article
Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
- Bárbara Vieira Carneiro
, - Lucas Lonardoni Crozatti ,
- Pedro Vitale Mendes ,
- Antonio Paulo Nassar Júnior ,
- Leandro Utino Taniguchi
Abstract
Original ArticleComparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
Rev Bras Ter Intensiva. 2022;34(2):220-226
DOI 10.5935/0103-507X.20220019-en
- Bárbara Vieira Carneiro ,
- Lucas Lonardoni Crozatti ,
- Pedro Vitale Mendes ,
- Antonio Paulo Nassar Júnior ,
- Leandro Utino Taniguchi
Views2ABSTRACT
Objective:
To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance.
Methods:
We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient’s probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians’ categories. We also stratified the results according to randomized question framing.
Results:
We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians’ experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians.
Conclusion:
Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals’ prediction. Question framing affected the predictive performance of surrogates but not of physicians.
Keywords:Critical illnessDecision MakingDelivery of health careHospitalizationIntensive care unitsInternship and residencyMortalityPrognosisSee moreViews2
Abstract
Original ArticleComparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
Rev Bras Ter Intensiva. 2022;34(2):220-226
DOI 10.5935/0103-507X.20220019-en
- Bárbara Vieira Carneiro ,
- Lucas Lonardoni Crozatti ,
- Pedro Vitale Mendes ,
- Antonio Paulo Nassar Júnior ,
- Leandro Utino Taniguchi
Views2ABSTRACT
Objective:
To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance.
Methods:
We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient’s probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians’ categories. We also stratified the results according to randomized question framing.
Results:
We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians’ experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians.
Conclusion:
Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals’ prediction. Question framing affected the predictive performance of surrogates but not of physicians.
Keywords:Critical illnessDecision MakingDelivery of health careHospitalizationIntensive care unitsInternship and residencyMortalityPrognosisSee more
- Bárbara Vieira Carneiro
-
Original Article
Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study
- Yuri de Albuquerque Pessoa dos Santos ,
- Mauricio Staib Younes-Ibrahim,
- Lucas Lonardoni Crozatti,
- Dante Raglione ,
- Luis Carlos Maia Cardozo Junior, [ … ],
- Pedro Vitale Mendes
Abstract
Original ArticleAdherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study
Rev Bras Ter Intensiva. 2020;32(1):37-42
DOI 10.5935/0103-507X.20200007
- Yuri de Albuquerque Pessoa dos Santos ,
- Mauricio Staib Younes-Ibrahim,
- Lucas Lonardoni Crozatti,
- Dante Raglione ,
- Luis Carlos Maia Cardozo Junior,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Leandro Utino Taniguchi ,
- Marcelo Park,
- Pedro Vitale Mendes
Views0ABSTRACT
Objective:
To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital.
Methods:
In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis.
Results:
Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 – 2.75) and coagulopathy OR 2.77 (95%CI 1.66 – 4.60). The upper gastrointestinal bleeding incidence was 12.8%.
Conclusion:
Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.
Keywords:Anti-ulcer agentsCritical careCritical illnessGastrointestinal hemorrhagePeptic ulcerTherapeutic adherence complianceSee moreViews0Abstract
Original ArticleAdherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study
Rev Bras Ter Intensiva. 2020;32(1):37-42
DOI 10.5935/0103-507X.20200007
- Yuri de Albuquerque Pessoa dos Santos ,
- Mauricio Staib Younes-Ibrahim,
- Lucas Lonardoni Crozatti,
- Dante Raglione ,
- Luis Carlos Maia Cardozo Junior,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Leandro Utino Taniguchi ,
- Marcelo Park,
- Pedro Vitale Mendes
Views0ABSTRACT
Objective:
To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital.
Methods:
In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis.
Results:
Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 – 2.75) and coagulopathy OR 2.77 (95%CI 1.66 – 4.60). The upper gastrointestinal bleeding incidence was 12.8%.
Conclusion:
Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.
Keywords:Anti-ulcer agentsCritical careCritical illnessGastrointestinal hemorrhagePeptic ulcerTherapeutic adherence complianceSee more
- Yuri de Albuquerque Pessoa dos Santos
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