ArticleBMJ supportive & palliative care2022
Imminent death: clinician certainty and accuracy of prognostic predictions.
Article in BMJ supportive & palliative care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Determining timeframes to death for imminently dying patients: a retrospective cohort study.BMC palliative care · 2025Article
- 'How long do you think?' Unresponsive dying patients in a specialist palliative care service: A consecutive cohort study.Palliative medicine · 2024Article
- Care of the dying person before and during the COVID-19 pandemic: A quality improvement project.Future healthcare journal · 2020Article
- Temporal convolutional networks allow early prediction of events in critical care.Journal of the American Medical Informatics Association : JAMIA · 2020Article
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Authors and funding
6 authors.
Funding
Abstract
objectivesTo determine the accuracy of predictions of dying at different cut-off thresholds and to acknowledge the extent of clinical uncertainty.
designSecondary analysis of data from a prospective cohort study.
settingAn online prognostic test, accessible by eligible participants across the UK.
participantsEligible participants were members of the Association of Palliative Medicine. 99/166 completed the test (60%), resulting in 1980 estimates (99 participants × 20 summaries).
main outcome measuresThe probability of death occurring within 72 hours (0% certain survival-100% certain death) for 20 patient summaries. The estimates were analysed using five different thresholds: 50/50%, 40/60%, 30/70%, 20/80% and 10/90%, with percentage values between these extremes being regarded as 'indeterminate'. The positive predictive value (PPV), negative predictive value (NPV) and the number of indeterminate cases were calculated for each cut-off.
resultsUsing a <50% versus >50% threshold produced a PPV of 62%, an NPV of 74% and 5% indeterminate cases. When the threshold was changed to ≤10% vs ≥90%, the PPV and NPV increased to 75% and 88%, respectively, at the expense of an increase of indeterminate cases up to 62%.
conclusionWhen doctors assign a very high (≥90%) or very low (≤10%) probability of imminent death, their prognostic accuracy is improved; however, this increases the number of 'indeterminate' cases. This suggests that clinical predictions may continue to have a role for routine prognostication but that other approaches (such as the use of prognostic scores) may be required for those cases where doctors' estimates are indeterminate.
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