Performance of Critical Care Outcome Prediction Models in an Intermediate Care Unit

Rebeccah M. Brusca, Catherine Simpson, Sarina K. Sahetya, Zeba Noorain, Varshitha Tanykonda, R. Scott Stephens, Dale M. Needham, David N. Hager

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalJournal of Intensive Care Medicine
DOIs
StateAccepted/In press - 2019

Keywords

  • intermediate care unit
  • mortality prediction
  • outcome prediction
  • progressive care
  • stepdown care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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