ArticlePloS one2019
Short-term mortality in older medical emergency patients can be predicted using clinical intuition: A prospective study.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Machine learning for risk stratification in the emergency department (MARS-ED): a randomized controlled trial.Nature communications · 2025Trial
- A comparison of machine learning models versus clinical evaluation for mortality prediction in patients with sepsis.PloS one · 2021Trial
- The surprise question: predictive accuracy in an unselected emergency department population - a prospective study in nurses and physicians.Annals of medicine · 2025Article
- Exploiting the Features of Clinical Judgment to Improve Assessment of Disease Severity in the Emergency Department: An Acutelines Study.Journal of clinical medicine · 2024Article
- Machine learning for risk stratification in the emergency department (MARS-ED) study protocol for a randomized controlled pilot trial on the implementation of a prediction model based on machine learning technology predicting 31-day mortality in the emergency department.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Acute internal medicine physicians' clinical intuition based on acute care telephone referral: A prospective study.PloS one · 2024Article
- Accuracy of the "Surprise Question" in Predicting Long-Term Mortality Among Older Patients Admitted to the Emergency Department: Comparison Between Emergency Physicians and Nurses in a Multicenter Longitudinal Study.Palliative medicine reports · 2024Article
- The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department.Journal of clinical medicine · 2023Article
- Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care.BMC palliative care · 2021Article
- Article
- Usability of the Surprise Question by Nurses and Patients' Families for Risk Stratification in Emergency Patients: A Prospective Cohort Study.Inquiry : a journal of medical care organization, provision and financingArticle
- Looking Good From the End of Bed: Surgical Clinical Intuition.ANZ journal of surgeryObservational
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOlder emergency department (ED) patients are at risk for adverse outcomes, however, it is hard to predict these. We aimed to assess the discriminatory value of clinical intuition, operationalized as disease perception, self-rated health and first clinical impression, including the 30-day surprise question (SQ: "Would I be surprised if this patient died in the next 30 days" of patients, nurses and physicians. Endpoints used to evaluate the discriminatory value of clinical intuition were short-term (30-day) mortality and other adverse outcomes (intensive/medium care admission, prolonged length of hospital stay, loss of independent living or 30-day readmission).
methodsIn this prospective, multicentre cohort study, older medical patients (≥65 years), nurses and physicians filled in scores regarding severity of illness and their concerns (i.e. disease perception and clinical impression scores) immediately after arrival of the patient in the ED. In addition, patients filled in a self-rated health score and nurses and physicians answered the SQ. Area under the curves (AUCs) of receiver operating characteristics (ROCs) were calculated.
resultsThe median age of the 602 included patients was 79 years and 86.7% were community dwelling. Within 30 days, 66 (11.0%) patients died and 263 (43.7%) patients met the composite endpoint. The severity of concern score of both nurses and physicians yielded the highest AUCs for 30-day mortality (for both 0.75; 95%CI 0.68-0.81). AUCs for the severity of illness score and SQ of nurses and physicians ranged from 0.71 to 0.74 while those for the disease perception and self-rated health of patients ranged from 0.64 to 0.69. The discriminatory value of the scores for the composite endpoint was lower (AUCs ranging from 0.60 to 0.67). We used scores that have not been previously validated which could influence their generalisability.
conclusionClinical intuition,-disease perception, self-rated health and first clinical impression-documented at an early stage after arrival in the ED, is a useful clinical tool to predict mortality and other adverse outcomes in older ED patients. Highest discriminatory values were found for the nurses' and physicians' severity of concern score. Intuition may be helpful for the implementation of personalised medical care in the future.
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