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Comparing Time-Fixed Mortality Prediction Models and Their Effect on ICU Performance Metrics Using the Simplified Acute Physiology Score 3
- Source :
- Critical care medicine. 44(11)
- Publication Year :
- 2016
-
Abstract
- 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) 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.
- Subjects :
- Male
medicine.medical_specialty
Critical Care and Intensive Care Medicine
Logistic regression
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Goodness of fit
Intensive care
Outcome Assessment, Health Care
medicine
Humans
030212 general & internal medicine
Hospital Mortality
Simplified Acute Physiology Score
Intensive care medicine
Aged
Retrospective Studies
Sweden
Models, Statistical
business.industry
030208 emergency & critical care medicine
Retrospective cohort study
Middle Aged
Benchmarking
Intensive Care Units
Standardized mortality ratio
Logistic Models
Cohort
Female
business
Cohort study
Subjects
Details
- ISSN :
- 15300293
- Volume :
- 44
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Critical care medicine
- Accession number :
- edsair.doi.dedup.....00dd0cb3ecba9bfe20bb183ab8b6073c