The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality
Authors: Cox Eline G. M. , Onrust Marisa , Vos Madelon E. , Paans Wolter , Dieperink Willem , Koeze Jacqueline , van der Horst Iwan C. C. , Wiersema Renske ,   SICS Study Group & SOCCS Student Team, van der Aart Tamar , Azdahic Amila , Benjamins Diede , Bergsma Anke , Bergsma Yorick , Boekema Jeroen , Braun Vera , Bremer Berend , de Bruin Jan-Paul , Chen Elisa , Dankfort Chantal , Delfsma Karin , Dieleman Isabel , Dijkstra Allysa , Dijkstra Alma , Doornbos Elsa , Eck Ruben , van Elst Rebecca , Erceg Dajana , Geertzen Koen , Govaerts Chris , Groothof Dion , Hagenauw Elisabeth , Heeres Xantia , Hiemstra Bart , Hoogland Jildou , Horstink Gerben , Huizenga Maike , Irk Alexander , Jansen Astrid , de Jonge Thibault , Kaufmann Thomas , Keuning Britt , Keus Eric , Koerts Charlotte , van der Kooi Evelyn , Koopmans Femia , Koops Lisa , Koster Geert , de Leeuw Menno , Mastenbroek Lothar , Meetsma Ahra , Miedema Gwen , Pelsma Hidde , Pijpstra George , Pruckl Sarah , Roelofs Arlinde , Schagen Maaike , Schilte Carine , Selles Kim , Sluiter Elma , Smit Anna , van der Starre Lou , van Stee Paul , Takkenkamp Tim , Theunis Melanie , Tijsma Leonie , Tombat Kabir , Trouwborst Nymke , Uiterwijk Fennie , van der Veen Nynke , Meilink Dorje , Vinke Bart , Visser Erin Anne , Wiersma Brenda , Wijma Marleen , Wiltingh Hinse , Wolters Jelle 
Published: November 2021

Abstract
Background
Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students’, nurses’, and physicians’ estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up.

Methods
The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians.

Results
In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed.

Conclusions
Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.