Friday, March 23, 2018
A Little Macabre But A Worthwhile Study Confirming The Value Of Some Important ICU Scoring Systems.
This appeared last week:
Published March 13 2018, 7:25am EDT
Using clinical data from more than 200 hospital intensive care units, Philips Healthcare has shown that three ICU risk scores—designed for different purposes—performed well as a marker of severity of illness at admission and throughout the ICU stay.
The analysis of de-identified data from more than 560,000 ICU patient stays contributed by 333 ICUs, covering almost 39 million patient-hours of ICU care, reveal that it is possible for risk models to perform well even when deployed for uses other than what they were originally intended.
Three risk scores were evaluated as predictors of mortality risk: Acute Physiology and Chronic Health Evaluation IV (APACHE), designed to estimate the risk of death on admission to the ICU; Discharge Readiness Score (DRS), designed to assist ICU discharge decisions by estimating the risk of death in the first 48 hours after the patient leaves the ICU; and Sequential Organ Failure Assessment (SOFA), designed to assess organ failure risk in patients with sepsis.
“Each was developed for a different purpose,” says Omar Badawi, director of clinical analytics and reporting for the eICU program at Philips Health Systems. “What we find is there are a lot of risk models that are used in the ICU, and as soon as they’re available for one thing, clinicians tend to want to use them for other purposes. There’s a long history of algorithms being repurposed.”
Results of the non-intervention cohort study, published in the March issue of the journal Critical Care Medicine, report that APACHE, DRS and SOFA all demonstrated good accuracy in predicting the risk of death in the ICU and the risk of death within 24 hours. However, of the three scores, DRS had the highest predictive value.
These scores are all useful and help clinicians provide a more accurate assessment of just what a patient’s chances are for recovery.
This is important as once it is clear the chances are vanishingly small it is possible to, in good conscience, not subject the dying to unnecessary and futile interventions.
Important work in my view – as a former ICU specialist.
Posted by Dr David G More MB PhD at Friday, March 23, 2018