IDENTIFICATION OF FUTILITY IN INTENSIVE-CARE

Rising costs of intensive care and the ability to prolong the life of critically ill patients creates a need to recognise early those patien ts who will die despite treatment. We used changes in a modified APACH E II score (organ failure score) to make daily predictions of individu al outcome in 3600 patients. 137 patients were predicted to die and of these, 131 (95.6%) died within 90 days of discharge from hospital (se nsitivity 23.4%, specificity 99.8%); a false-positive diagnosis rate o f 4.4%. 2 of the 6 survivors have subsequently died but 4 are alive wi th good quality of life. Patients predicted to die stayed 1492 days in intensive care and incurred 16.7% of total intensive care expenditure and 46.4% of the cost of all patients that died. Median survival afte r a prediction to die was 2 days, accounting for 62% of intensive care patient days in this patient group, giving an effective intensive car e cost per survivor of UK pound 129 651. If used prospectively, this a lgorithm has the potential to indicate the futility of continued inten sive care but at the cost of 1 in 20 patients who would survive if int ensive care were continued.