Hospital mortality prediction for intermediate care patients: Assessing the generalizability of the Intermediate Care Unit Severity Score (IMCUSS)

David Northrop Hager, Varshitha Tanykonda, Zeba Noorain, Sarina Sahetya, Catherine E. Simpson, Juan Felipe Lucena, Dale Needham

Research output: Contribution to journalArticle

Abstract

Purpose: The Intermediate Care Unit Severity Score (IMCUSS) is an easy to calculate predictor of in-hospital death, and the only such tool developed for patients in the intermediate care setting. We sought to examine its external validity. Materials and methods: Using data from patients admitted to the intermediate care unit (IMCU) of an urban academic medical center from July to December of 2012, model discrimination and calibration for predicting in-hospital death were assessed using the area under the receiver operating characteristic (AUROC) and the Hosmer-Lemeshow goodness-of-fit chi-squared (HL GOF X2) test, respectively. The standardized mortality ratio (SMR) with 95% confidence intervals (95% CI) was also calculated. Results: The cohort included data from 628 unique admissions to the IMCU. Overall hospital mortality was 8.3%. The median IMCUSS was 10 (Interquartile Range: 0–16), with 229 (36%) patients having a score of zero. The AUROC for the IMCUSS was 0.72 (95% CI: 0.64–0.78), the HL GOF X2 = 30.7 (P < 0.001), and the SMR was 1.22 (95% CI: 0.91–1.60). Conclusions: The IMCUSS exhibited acceptable discrimination, poor calibration, and underestimated mortality. Other centers should assess the performance of the IMCUSS before adopting its use.

Original languageEnglish (US)
Pages (from-to)94-98
Number of pages5
JournalJournal of Critical Care
Volume46
DOIs
StatePublished - Aug 1 2018

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Hospital Mortality
Patient Care
Confidence Intervals
ROC Curve
Calibration
Mortality

Keywords

  • Intermediate care
  • Mortality prediction
  • Outcome prediction score
  • Progressive care
  • Stepdown care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hospital mortality prediction for intermediate care patients : Assessing the generalizability of the Intermediate Care Unit Severity Score (IMCUSS). / Hager, David Northrop; Tanykonda, Varshitha; Noorain, Zeba; Sahetya, Sarina; Simpson, Catherine E.; Lucena, Juan Felipe; Needham, Dale.

In: Journal of Critical Care, Vol. 46, 01.08.2018, p. 94-98.

Research output: Contribution to journalArticle

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