ICU Topics > Prognostic Indicators

Prognostic Indicators

Prognostic indicators help guide clinical reasoning about a patient's potential for recovery and discharge trajectory. They inform goal-setting, discharge planning, and the intensity and direction of therapy. No single indicator is determinative — use them in combination with the patient's daily presentation, team input, and trajectory over time.

General ICU Prognostic Indicators

Positive Indicators Potentially Limiting Indicators
Absence of ICU-acquired weakness ICU-acquired weakness or neuromuscular dysfunction
Absence of delirium, or short delirium duration Prolonged or recurrent delirium
Participation in early mobilization and rehabilitation Prolonged bedrest or delayed initiation of therapy
No neuromuscular blocking agents or corticosteroid exposure Neuromuscular blocking agent and/or corticosteroid use
Higher premorbid functional status (independent prior to admission) Limited baseline function or pre-existing frailty
Fewer significant comorbid conditions Multiple or severe comorbidities
Shorter ICU and hospital length of stay Prolonged ICU stay (>7–14 days)
Hemodynamic stability achieved early Persistent hemodynamic instability

Ferrante et al., 2016; Herridge et al., 2003; Hopkins et al., 2017; Jackson et al., 2014; Jolley et al., 2016; Kress & Hall, 2014; Needham et al., 2010

Neuro-Specific Prognostic Indicators

Applicable to patients with stroke, TBI, and disorders of consciousness.

Positive Indicators Potentially Limiting Indicators
Ability to isolate active movement in all 4 extremities Inability to isolate movement in all 4 extremities
Absence of midline shift Presence of midline shift
Lower initial NIHSS score (stroke) Higher initial NIHSS score
Absence of visual or visuospatial deficits Presence of visual field cut, neglect, or visuospatial deficits
Favorable nature and mechanism of injury (e.g., focal, traumatic) Diffuse injury, anoxic brain injury, or DAI
Early signs of spontaneous neurological recovery Plateau or regression in neurological status
Higher pre-morbid functional and cognitive level Limited pre-morbid cognition or function

Ferrante et al., 2016; Hopkins et al., 2017; Jackson et al., 2014, 2015; Lannin et al., 2013

References

Ferrante, L. E., Pisani, M. A., Murphy, T. E., Gahbauer, E. A., Leo-Summers, L. S., & Gill, T. M. (2016). Factors associated with functional recovery among older intensive care unit survivors. American Journal of Respiratory and Critical Care Medicine, 194(3), 299–307. https://doi.org/10.1164/rccm.201506-1256OC

Herridge, M. S., Matte-Martyn, A., Diaz-Granados, N., Al-Saidi, F., Guest, C. B., & Cook, D. (2003). One-year outcomes in survivors of the acute respiratory distress syndrome. The New England Journal of Medicine, 348, 683–693.

Hopkins, R. O., Suchyta, M. R., Kamdar, B. B., Darowski, E., Jackson, J. C., & Needham, D. M. (2017). Instrumental activities of daily living after critical illness: A systematic review. Annals of the American Thoracic Society, 14(8), 1332–1343. https://doi.org/10.1513/AnnalsATS.201701-059SR

Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., ... & Ely, E. W. (2014). Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study. The Lancet Respiratory Medicine, 2(5), 369–379. https://doi.org/10.1016/S2213-2600(14)70051-7

Jackson, J. C., Mitchell, N., & Hopkins, R. O. (2015). Cognitive functioning, mental health, and quality of life in ICU survivors: An overview. Psychiatric Clinics of North America, 38(1), 91–104. https://doi.org/10.1016/j.psc.2014.11.002

Jolley, S. E., Bunnell, A. E., & Hough, C. L. (2016). ICU-acquired weakness. Chest, 150(5), 1129–1140. https://doi.org/10.1016/j.chest.2016.03.045

Kress, J. P., & Hall, J. B. (2014). ICU-acquired weakness and recovery from critical illness. New England Journal of Medicine, 370(17), 1626–1635. https://doi.org/10.1056/NEJMra1209390

Lannin, N. A., Cusick, A., McLachlan, R., & Allaous, J. (2013). Observed recovery sequence in neurobehavioral function after severe traumatic brain injury. The American Journal of Occupational Therapy, 67(5), 543–549. https://doi.org/10.5014/ajot.2013.008094

Needham, D. M., Korupolu, R., Zanni, J. M., Pradhan, P., Colantuoni, E., Palmer, J. B., ... & Fan, E. (2010). Early physical medicine and rehabilitation for patients with acute respiratory failure: A quality improvement project. Archives of Physical Medicine and Rehabilitation, 91(4), 536–542. https://doi.org/10.1016/j.apmr.2010.01.002