Key result
Proxy assessment of pre-admission PROMs shows insufficient reliability versus patient self-assessment.
Why the study?
Pre-admission patient-reported outcome measures are frequently collected by proxies for prognostication and treatment decisions, but their reliability has not been thoroughly investigated.
Does proxy assessment reliably reflect pre-admission patient-reported outcome measures in surgical adult patients?
Observational (n=204)
Yes
Does proxy assessment reliably reflect pre-admission patient-reported outcome measures in surgical adult patients?
Proxy assessments of pre-admission status using standard patient-reported outcome measures are insufficiently reliable and show significant bias, particularly for ICU patients, suggesting they should be used with caution.
Proxy reports should not substitute for patient-reported outcomes; leaves open the need for validated proxy tools in critical care.
BACKGROUND: Pre-admission status obtained through patient-reported outcome measures is an essential metric in both clinical and research settings for prognostication and treatment decisions. It is frequently collected by proxies, although its reliability has yet to be thoroughly investigated. The objective was to determine the reliability of proxy assessments regarding pre-ICU admission status via patient-reported outcome measures and to explore the impact of the ICU setting on these assessments. METHODS: Prospective multicentre observational study in two tertiary care university hospitals in Germany, including surgical adult patients able to independently answer the patient-reported outcome measures (SF-36, EQ-5D-5L, WHODAS 2.0, IADL, and Barthel Index) with a proxy available. Patients were interviewed pre-operatively, while proxies were interviewed post-operatively in the ICU or normal ward, depending on the patient's location. The reliability of patient-reported outcome measures was analyzed using Bland-Altman plots and Cohen's kappa. RESULTS: Of 204 patient-proxy pairs, 102 were admitted to an ICU. The median patient and proxy age were 69 and 64 years, with 41% and 68% female, respectively. Bland-Altman plots demonstrated insufficient reliability of proxy ratings, as the 95% limits of agreement fell outside the minimal clinically important difference (MCID) for all questionnaires. However, a significant bias was evident only among ICU patients, showing worse ratings from proxies for the WHODAS 2.0, IADL, and subsets of the SF-36. For the EQ-5D, bias appeared in both the ICU and non-ICU cohorts. The dichotomous analysis of the within-pairs-difference supported the findings, revealing a high proportion of pairs with differences outside the MCID (n (%)-SF-36 PCS normal ward: 47 (46%), ICU: 58 (57%); SF-36 MCS normal ward: 59 (58%), ICU: 62 (61%); WHODAS 2.0 normal ward: 58 (57%), ICU: 78 (77%); EQ-5D-5L normal ward: 40 (39%), ICU: 46 (45%); Barthel-Index normal ward: 22 (22%), ICU: 21 (21%)). Cohen's kappa indicated moderate reliability for the IADL. CONCLUSION: The reliability of proxy assessment with the instruments used was insufficient, exhibiting a significant bias in the pre-admission status of ICU patients; therefore, it should be applied with caution. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03785444-28th of December 2018).
No takes yet. Share an insight, caveat, or question.
Grunow et al. (2025) conducted an observational in Surgical patients requiring post-operative care (n=204). Proxy assessment of pre-admission PROMs vs. Patient self-assessment was evaluated on Reliability of proxy assessments of PROMs evaluated via Bland-Altman plots and Cohen's kappa. Proxy assessment of pre-admission patient-reported outcome measures demonstrated insufficient reliability, with 95% limits of agreement falling outside the minimal clinically important difference.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: