TY - JOUR
T1 - Performance of Critical Care Outcome Prediction Models in an Intermediate Care Unit
AU - Brusca, Rebeccah M.
AU - Simpson, Catherine E.
AU - Sahetya, Sarina K.
AU - Noorain, Zeba
AU - Tanykonda, Varshitha
AU - Stephens, R. Scott
AU - Needham, Dale M.
AU - Hager, David N.
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Intermediate care units (IMCUs) are heterogeneous in design and operation, which makes comparative effectiveness studies challenging. A generalizable outcome prediction model could improve such comparisons. However, little is known about the performance of critical care outcome prediction models in the intermediate care setting. The purpose of this study is to evaluate the performance of the Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and version 3 (SAPS 3), and Mortality Probability Model version III (MPM0III) in patients admitted to a well-characterized IMCU. Materials and Methods: In the IMCU of an academic medical center (July to December 2012), the discrimination and calibration of each outcome prediction model were evaluated using the area under the receiver–operating characteristic and Hosmer-Lemeshow goodness-of-fit test, respectively. Standardized mortality ratios (SMRs) were also calculated. Results: The cohort included data from 628 unique IMCU admissions with an inpatient mortality rate of 8.3%. All models exhibited good discrimination, but only the SAPS II and MPM0III were well calibrated. While the APACHE II and SAPS 3 both markedly overestimated mortality, the SMR for the SAPS II and MPM0III were 0.91 and 0.91, respectively. Conclusions: The SAPS II and MPM0III exhibited good discrimination and calibration, with slight overestimation of mortality. Each model should be further evaluated in multicenter studies of patients in the intermediate care setting.
AB - Background: Intermediate care units (IMCUs) are heterogeneous in design and operation, which makes comparative effectiveness studies challenging. A generalizable outcome prediction model could improve such comparisons. However, little is known about the performance of critical care outcome prediction models in the intermediate care setting. The purpose of this study is to evaluate the performance of the Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and version 3 (SAPS 3), and Mortality Probability Model version III (MPM0III) in patients admitted to a well-characterized IMCU. Materials and Methods: In the IMCU of an academic medical center (July to December 2012), the discrimination and calibration of each outcome prediction model were evaluated using the area under the receiver–operating characteristic and Hosmer-Lemeshow goodness-of-fit test, respectively. Standardized mortality ratios (SMRs) were also calculated. Results: The cohort included data from 628 unique IMCU admissions with an inpatient mortality rate of 8.3%. All models exhibited good discrimination, but only the SAPS II and MPM0III were well calibrated. While the APACHE II and SAPS 3 both markedly overestimated mortality, the SMR for the SAPS II and MPM0III were 0.91 and 0.91, respectively. Conclusions: The SAPS II and MPM0III exhibited good discrimination and calibration, with slight overestimation of mortality. Each model should be further evaluated in multicenter studies of patients in the intermediate care setting.
KW - intermediate care unit
KW - mortality prediction
KW - outcome prediction
KW - progressive care
KW - stepdown care
UR - http://www.scopus.com/inward/record.url?scp=85074421547&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074421547&partnerID=8YFLogxK
U2 - 10.1177/0885066619882675
DO - 10.1177/0885066619882675
M3 - Article
C2 - 31635507
AN - SCOPUS:85074421547
SN - 0885-0666
VL - 35
SP - 1529
EP - 1535
JO - Journal of Intensive Care Medicine
JF - Journal of Intensive Care Medicine
IS - 12
ER -