Physician prognostication of functional outcomes appears to be even worse than prognostication of mortality. Among approximately 300 patients in Pennsylvania, clinician predictions poorly discriminated functional outcomes and discriminated worse than predictions of mortality (13). In a single-center study, over half of ICU attending physicians recalled being surprised to discover that patients in whom they had recommended limiting life support on the basis of anticipated poor outcomes had in fact survived, sometimes with no functional impairment (14).

Predictive models for functional outcomes are also inadequate. Acute severity of illness is not associated with functional outcomes among survivors (15). Baseline impairments dominate subsequent outcomes but are as yet inadequately characterized in clinical practice and research (16). In addition, methodological problems plague prognostic models. First, most predictive models are validated in terms of discrimination (how often, on average, nonsurvivors have higher