Does prediction of outcome alter patient management?

L. S. Murray*, G. M. Teasdale, G. D. Murray, B. Jennett, J. D. Miller, J. D. Pickard, M. D M Shaw, J. Achilles, S. Bailey, P. Jones, J. Lacey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

A patient's prognosis is a key factor for the clinicians involved in management. We set out to determine if provision of computer-based predictions of outcome after severe head injury resulted in measurable changes in patient management. In particular, we wondered whether introduction of the predictive system would alter the relation between severity of injury and "intensity" of management. 1025 patients admitted to four British neurosurgical units between 1986 and 1989 following a severe head injury, and who were either in coma for 6 h or had an operation for acute intracranial haematoma, were studied. Specified aspects of intensive management were recorded and all patients were followed up after six months. The study had three phases: a baseline period of at least one year before the introduction of computer-based outcome prediction, one year when predictions were provided at specified times, and a final six months when prediction was withdrawn. While predictions were being provided, there was an increase in the use of specified aspects of intensive care in patients predicted to have a good outcome, but a 39% reduction in the use of these same aspects of intensive care in patients predicted to have the worst outcome. There was no evidence that the provision of predictions affected overall outcome, length of stay, or the recording of explicit decisions to limit treatment. We have demonstrated that the introduction of a routine prediction service can alter patient management.

Original languageEnglish
Pages (from-to)1487-1491
Number of pages5
JournalThe Lancet
Volume341
Issue number8859
Publication statusPublished - 1 Dec 1993

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