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Comparing Time-Fixed Mortality Prediction Models and Their Effect on ICU Performance Metrics Using the Simplified Acute Physiology Score 3.
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
Prescient Healthcare Consulting, Charlottesville, VA.
The Swedish Intensive Care Registry, Karlstad, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
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2016 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 44, no 11Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016. Vol. 44, no 11
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-133991DOI: 10.1097/CCM.0000000000001877ISI: 000400824800003PubMedID: 27513546OAI: oai:DiVA.org:liu-133991DiVA: diva2:1066097
Note

Funding agencies: Swedish Intensive Care Registry, SIR

Available from: 2017-01-17 Created: 2017-01-17 Last updated: 2017-05-31

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Engerström, LarsSjöberg, FolkeFredrikson, MatsWalther, Sten M
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDepartment of Thoracic and Vascular SurgeryDepartment of Anaesthesiology and Intensive Care in NorrköpingDivision of Clinical SciencesDepartment of Hand and Plastic SurgeryDivision of Neuro and Inflammation ScienceDivision of Cardiovascular Medicine
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