The effect of patient age on perceived resuscitation outcomes by practitioners.

Background: When health care practitioners assist patients with decisions about advance directives, the risks and benefits of resuscitation options are often discussed. Whether practitioners have accurate perceptions about in-hospital resuscitation success rates is not known, nor is the effect of patient age on these perceptions. Age on its own has not been definitively associated with decreased inpatient survival after resuscitation. The goal of this study was to compare perceived resuscitation success rates with the actual observed rates at our hospital and to assess the effect of patient age on the perceived rates.

Methods: A survey-based observational study of on-duty hospital-based faculty, internal medicine resident physicians, and critical care nurses was performed over a week-long recruitment period to estimate their perception of in-hospital resuscitation success rates for patients of different ages. The survey response rate was 100%.

Results: Patient survival to hospital discharge following in-hospital resuscitation during a three-year period at New Hanover Regional Medical Center was 29.22% for patients < 70 years old and 20.13% for patients > or = 70. The perceived in-hospital resuscitation success rates were 38.76% for patients < 70 and 21.24% for patients > or = 70. This corresponds to a statistically significant overestimation of resuscitation success rates for patients < 70 years old (p < 0.001), although predictions were fairly accurate for patients > or = 70. When posed with one of two clinical scenarios where the only different variable was patient age, participants were statistically more likely to predict success for the younger patient. Subgroup analysis showed general agreement in the estimates between the three major types of practitioners, and factors such as length of experience in their current position and time since their last Advanced Cardiac Life Support (ACLS) recertification course did not have a significant impact on these perceptions.

Conclusions: Practitioners may overestimate resuscitation success rates in patients younger than 70. Disseminating information about ACLS success rates to clinicians, and what factors affect or do not affect these rates, seems essential.