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Erschienen in: Journal of General Internal Medicine 10/2010

01.10.2010 | Reviews

The Empirical Basis for Determinations of Medical Futility

verfasst von: MD Ezra Gabbay, MD Jose Calvo-Broce, MD Klemens B. Meyer, MD Thomas A. Trikalinos, PhD Joshua Cohen, MD David M. Kent

Erschienen in: Journal of General Internal Medicine | Ausgabe 10/2010

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Abstract

BACKGROUND

Decisions to limit treatment in critically ill patients often rely on publications that make claims of futility based on outcome data. Our objective was to systematically review the criteria for futility and the strength of empirical evidence across clinical studies that purport to support or refute claims of futility.

METHODS

The MEDLINE database was searched for relevant articles published between1980 and 2008. Selected studies reported original outcome data in critically ill or cardiac arrest patients and claimed that these data can support or refute decisions to limit treatment in comparable patients. Two authors independently abstracted data on patient characteristics, intervention, outcomes, cost, and design.

RESULTS

Forty seven studies supporting a claim of futility and 45 refuting it were reviewed. Median point estimate for adverse outcome in studies supporting claims of futility was 100% (range 75% to 100%); median lower 95% confidence limit was 91% (range 48% to 99%). Explicit thresholds for futility were missing in 88% of articles. The original criteria for quantitative futility were fulfilled by only 28% of data, and almost exclusively in studies of cardiopulmonary resuscitation (CPR) for cardiac arrest. Substantial statistical overlap was observed between data brought in support of futility claims and data brought to refute them.

CONCLUSIONS

Most studies that purport to guide determinations of futility are based on insufficient data to provide statistical confidence for clinical decision-making. They usually lack explicit a priori thresholds for determination of futility. Many studies draw disparate conclusions based on statistically similar data. In most circumstances these problems preclude confident determinations of futility.
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Metadaten
Titel
The Empirical Basis for Determinations of Medical Futility
verfasst von
MD Ezra Gabbay
MD Jose Calvo-Broce
MD Klemens B. Meyer
MD Thomas A. Trikalinos
PhD Joshua Cohen
MD David M. Kent
Publikationsdatum
01.10.2010
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 10/2010
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1445-3

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