As one attempts to asses the outcomes of critically ill patients, one is confronted by the question of how to measure them, and which ones are important. A range of options exist. For instance, one may measure "hard" outcomes (mortality) - a straightforward metric which can be collected at different time intervals. Alternatively, one may collect "POEM" data (Patient Oriented Endpoint that Matters) which is more interested in quality of life, functional status and other more subjective issues like "satisfaction".
Question 25 from the first paper of 2013 asked the trainees to discuss the advantages and limitations of commonly used endpoints as a measure of quality of critical care. A question like this probably lends itself better to a tabulated answer, and so I went ahead and tabulated it (the table is made available below, and is identical to the table in the discussion section of Question 25).
Possible reading material for this topic may include the following resources:
As an interesting aside, a recent (2016) report by Turbull et al remarked that "peer-reviewed publications reporting patient outcomes after hospital discharge for ICU survivors have grown from 3 in the 1970s to more than 300 since 2000", and complained that "the ability to compare results across studies remains impaired by the 250 different instruments used" which means that virtually every second study used a different instrument (in total 425 eligible articles were reviewed).
Outcome measure | Advantages | Disadvantages |
ICU mortality |
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Hospital mortality |
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90-day mortality |
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1-year functional outcome |
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Young, Paul, et al. "End points for phase II trials in intensive care: Recommendations from the Australian and New Zealand clinical trials group consensus panel meeting." Critical Care and Resuscitation 15.3 (2013): 211. - this one is not available for free, but the 2012 version still is:
Young, Paul, et al. "End points for phase II trials in intensive care: recommendations from the Australian and New Zealand Clinical Trials Group consensus panel meeting." Critical Care and Resuscitation 14.3 (2012): 211.
Suter, P., et al. "Predicting outcome in ICU patients." Intensive Care Medicine20.5 (1994): 390-397.
Martinez, Elizabeth A., et al. "Identifying Meaningful Outcome Measures for the Intensive Care Unit." American Journal of Medical Quality (2013): 1062860613491823.
Tipping, Claire J., et al. "A systematic review of measurements of physical function in critically ill adults." Critical Care and Resuscitation 14.4 (2012): 302.
Gunning, Kevin, and Kathy Rowan. "Outcome data and scoring systems." Bmj319.7204 (1999): 241-244.
Woodman, Richard, et al. Measuring and reporting mortality in hospital patients. Australian Institute of Health and Welfare, 2009.
Vincent, J-L. "Is Mortality the Only Outcome Measure in ICU Patients?."Anaesthesia, Pain, Intensive Care and Emergency Medicine—APICE. Springer Milan, 1999. 113-117.
Rosenberg, Andrew L., et al. "Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures." Annals of internal medicine 138.11 (2003): 882-890.
Burack, Joshua H., et al. "Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons." The Annals of thoracic surgery 68.4 (1999): 1195-1200.
Hayes, J. A., et al. "Outcome measures for adult critical care: a systematic review." Health technology assessment (Winchester, England) 4.24 (1999): 1-111.
RUBENFELD, GORDON D., et al. "Outcomes research in critical care: results of the American Thoracic Society critical care assembly workshop on outcomes research." American journal of respiratory and critical care medicine 160.1 (1999): 358-367.
Turnbull, Alison E., et al. "Outcome Measurement in ICU Survivorship Research From 1970 to 2013: A Scoping Review of 425 Publications." Critical care medicine (2016).