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Comparing Time-Fixe...
Comparing Time-Fixed Mortality Prediction Models and Their Effect on ICU Performance Metrics Using the Simplified Acute Physiology Score 3.
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- Engerström, Lars (författare)
- Linköpings universitet,Institutionen för medicin och hälsa,Medicinska fakulteten,Region Östergötland, Thorax-kärlkliniken i Östergötland,Region Östergötland, Anestesi- och intensivvårdskliniken VIN
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- Kramer, Andrew A. (författare)
- Prescient Healthcare Consulting, Charlottesville, VA
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- Nolin, Thomas (författare)
- The Swedish Intensive Care Registry, Karlstad, Sweden
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- Sjöberg, Folke (författare)
- Linköpings universitet,Avdelningen för kliniska vetenskaper,Medicinska fakulteten,Region Östergötland, Hand- och plastikkirurgiska kliniken US
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- Karlström, Göran (författare)
- The Swedish Intensive Care Registry, Karlstad, Sweden
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- Fredrikson, Mats (författare)
- Linköpings universitet,Avdelningen för neuro- och inflammationsvetenskap,Medicinska fakulteten,Academic Research Center, Linköping University, Linköping, Sweden
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- Walther, Sten M (författare)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Thorax-kärlkliniken i Östergötland
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(creator_code:org_t)
- Lippincott Williams & Wilkins, 2016
- 2016
- Engelska.
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Ingår i: Critical Care Medicine. - : Lippincott Williams & Wilkins. - 0090-3493 .- 1530-0293. ; 44:11
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- OBJECTIVES: To examine ICU performance based on the Simplified Acute Physiology Score 3 using 30-day, 90-day, or 180-day mortality as outcome measures and compare results with 30-day mortality as reference.DESIGN: Retrospective cohort study of ICU admissions from 2010 to 2014.SETTING: Sixty-three Swedish ICUs that submitted data to the Swedish Intensive Care Registry.PATIENTS: The development cohort was first admissions to ICU during 2011-2012 (n = 53,546), and the validation cohort was first admissions to ICU during 2013-2014 (n = 57,729).INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Logistic regression was used to develop predictive models based on a first level recalibration of the original Simplified Acute Physiology Score 3 model but with 30-day, 90-day, or 180-day mortality as measures of outcome. Discrimination and calibration were excellent for the development dataset. Validation in the more recent 2013-2014 database showed good discrimination (C-statistic: 0.85, 0.84, and 0.83 for the 30-, 90-, and 180-d models, respectively), and good calibration (standardized mortality ratio: 0.99, 0.99, and 1.00; Hosmer-Lemeshow goodness of fit H-statistic: 66.4, 63.7, and 81.4 for the 30-, 90-, and 180-d models, respectively). There were modest changes in an ICU's standardized mortality ratio grouping (< 1.00, not significant, > 1.00) when follow-up was extended from 30 to 90 days and 180 days, respectively; about 11-13% of all ICUs.CONCLUSIONS: The recalibrated Simplified Acute Physiology Score 3 hospital outcome prediction model performed well on long-term outcomes. Evaluation of ICU performance using standardized mortality ratio was only modestly sensitive to the follow-up time. Our results suggest that 30-day mortality may be a good benchmark of ICU performance. However, the duration of follow-up must balance between what is most relevant for patients, most affected by ICU care, least affected by administrative policies and practically feasible for caregivers.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
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