Imperial College London
Portrait Picture

Dr Chris Tomlinson

Faculty of Medicine, Department of Surgery & Cancer

Honorary Research Fellow
 
 
 
//

Contact

 

chris.tomlinson

 
 
//

Location

 

Burlington DanesHammersmith Campus

//

Summary

 

Publications

Citation

BibTex format

@article{White:2022:10.1136/bmjspcare-2018-001761,
author = {White, N and Reid, F and Vickerstaff, V and Harries, P and Tomlinson, C and Stone, P},
doi = {10.1136/bmjspcare-2018-001761},
journal = {BMJ Supportive & Palliative Care},
pages = {e785--e781},
title = {Imminent death: Clinician certainty and accuracy of prognostic predictions},
url = {http://dx.doi.org/10.1136/bmjspcare-2018-001761},
volume = {12},
year = {2022}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives To determine the accuracy of predictions of dying at different cut-off thresholds and to acknowledge the extent of clinical uncertainty.Design Secondary analysis of data from a prospective cohort study.Setting An online prognostic test, accessible by eligible participants across the UK.Participants Eligible 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 measures The 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.Results Using 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%.Conclusion When 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.
AU  - White,N
AU  - Reid,F
AU  - Vickerstaff,V
AU  - Harries,P
AU  - Tomlinson,C
AU  - Stone,P
DO  - 10.1136/bmjspcare-2018-001761
EP  - 781
PY  - 2022///
SN  - 2045-435X
SP  - 785
TI  - Imminent death: Clinician certainty and accuracy of prognostic predictions
T2  - BMJ Supportive & Palliative Care
UR  - http://dx.doi.org/10.1136/bmjspcare-2018-001761
UR  - http://hdl.handle.net/10044/1/70134
VL  - 12
ER  -
Download