Comparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: A linked-data cohort study

ObjectivesThe COVID-19 pandemic pressurised healthcare with increased shortage of care. This resulted in an increase of awareness for code status documentation (ie, whether limitations to specific life-sustaining treatments are in place), both in the medical field and in public media. However, it is unknown whether the increased awareness changed the prevalence and content of code status documentation for COVID-19 patients. We aim to describe differences in code status documentation between infectious patients before the pandemic and COVID-19 patients.SettingUniversity Medical Centre of Utrecht, a tertiary care teaching academic hospital in the Netherlands.ParticipantsA total of 1715 patients were included, 129 in the COVID-19 cohort (a cohort of COVID-19 patients, admitted from March 2020 to June 2020) and 1586 in the pre-COVID-19 cohort (a cohort of patients with (suspected) infections admitted between September 2016 to September 2018).Primary and secondary outcome measuresWe described frequency of code status documentation, frequency of discussion of this code status with patient and/or family, and content of code status.ResultsFrequencies of code status documentation (69.8% vs 72.7%, respectively) and discussion (75.6% vs 73.3%, respectively) were similar in both cohorts. More patients in the COVID-19 cohort than in the before COVID-19 cohort had any treatment limitation as opposed to full code (40% vs 25%). Within the treatment limitations, ‘no intensive care admission’ (81% vs 51%) and ‘no intubation’ (69% vs 40%) were more frequently documented in the COVID-19 cohort. A smaller difference was seen in ‘other limitation’ (17% vs 9%), while ‘no resuscitation’ (96% vs 92%) was comparable between both periods.ConclusionWe observed no difference in the frequency of code status documentation or discussion in COVID-19 patients opposed to a pre-COVID-19 cohort. However, treatment limitations were more prevalent in patients with COVID-19, especially ‘no intubation’ and ‘no intensive care admission’.

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Performance of Prognostic Scoring Systems in Trauma Patients in the Intensive Care Unit of a Trauma Center

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197226 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7226

Author(s):

Shao-Chun Wu ◽

Sheng-En Chou ◽

Hang-Tsung Liu ◽

Ting-Min Hsieh ◽

Wei-Ti Su ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Organ Dysfunction ◽

Scoring Systems ◽

Predictive Performance ◽

Apache Ii ◽

Trauma Patients ◽

Saps Ii ◽

Significant Difference ◽

Prognostic Scoring Systems

Background: Prediction of mortality outcomes in trauma patients in the intensive care unit (ICU) is important for patient care and quality improvement. We aimed to measure the performance of 11 prognostic scoring systems for predicting mortality outcomes in trauma patients in the ICU. Methods: Prospectively registered data in the Trauma Registry System from 1 January 2016 to 31 December 2018 were used to extract scores from prognostic scoring systems for 1554 trauma patients in the ICU. The following systems were used: the Trauma and Injury Severity Score (TRISS); the Acute Physiology and Chronic Health Evaluation (APACHE II); the Simplified Acute Physiology Score (SAPS II); mortality prediction models (MPM II) at admission, 24, 48, and 72 h; the Multiple Organ Dysfunction Score (MODS); the Sequential Organ Failure Assessment (SOFA); the Logistic Organ Dysfunction Score (LODS); and the Three Days Recalibrated ICU Outcome Score (TRIOS). Predictive performance was determined according to the area under the receiver operator characteristic curve (AUC). Results: MPM II at 24 h had the highest AUC (0.9213), followed by MPM II at 48 h (AUC: 0.9105). MPM II at 24, 48, and 72 h (0.8956) had a significantly higher AUC than the TRISS (AUC: 0.8814), APACHE II (AUC: 0.8923), SAPS II (AUC: 0.9044), MPM II at admission (AUC: 0.9063), MODS (AUC: 0.8179), SOFA (AUC: 0.7073), LODS (AUC: 0.9013), and TRIOS (AUC: 0.8701). There was no significant difference in the predictive performance of MPM II at 24 and 48 h (p = 0.37) or at 72 h (p = 0.10). Conclusions: We compared 11 prognostic scoring systems and demonstrated that MPM II at 24 h had the best predictive performance for 1554 trauma patients in the ICU.

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Comparison of Severity Scoring Systems in a Pediatric Intensive Care Unit in India: A Single-Center Prospective, Observational Cohort Study

Journal of Pediatric Intensive Care ◽

10.1055/s-0036-1584811 ◽

2016 ◽

Vol 06 (02) ◽

pp. 098-102

Author(s):

Sandeep Raina ◽

Jennifer Antin ◽

Vinayak Patki

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Pediatric Intensive Care ◽

Scoring Systems ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Single Center ◽

Severity Scoring ◽

Observational Cohort

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Prognostic Scoring Systems: Facing Difficult Decisions with Objective Data

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s096318010000089x ◽

1993 ◽

Vol 2 (2) ◽

pp. 185-191 ◽

Cited By ~ 2

Author(s):

Kent Sasse

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Scoring Systems ◽

The United States ◽

Assisted Ventilation ◽

Intensive Care Patients ◽

Coronary Care ◽

Cardiopulmonary Performance ◽

The Cost ◽

Prognostic Scoring Systems

In the United States, at least 6% of all hospital beds are in the intensive care unit (ICU) or coronary care unit. The cost of treating a patient in an intensive care unit averages from $2,000 to $3,500 per day. At least 10–40% of intensive care patients will not survive to hospital discharge. Today, every major category of disease may be found in the modern ICU; common diagnoses are septicemia, postsurgical complications, cerebrovascular accidents, gastrointestinal bleeding, neoplasia, and respiratory failure. ICUs employ some of the most sophisticated medical technology, routinely monitoring the cardiopulmonary performance of patients and often providing assisted ventilation. ICUs are high intensity in terms of their staffing, involving 24-hour physician supervision and nurse:patient ratios from 1:3 to 1:1.

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Predicting Patient Outcome from Intensive Care: A Guide to APACHE, MPM, SAPS, PRISM, and Other Prognostic Scoring Systems

Journal of Intensive Care Medicine ◽

10.1177/088506669000500107 ◽

1990 ◽

Vol 5 (1) ◽

pp. 33-52 ◽

Cited By ~ 39

Author(s):

Michael Seneff ◽

William A Knaus

Keyword(s):

Patient Outcome ◽

Intensive Care ◽

Scoring Systems ◽

Prognostic Scoring Systems

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The association between four scoring systems and 30-day mortality among intensive care patients with sepsis: a cohort study

Scientific Reports ◽

10.1038/s41598-021-90806-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tianyang Hu ◽

Huajie Lv ◽

Youfan Jiang

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Scoring Systems ◽

Roc Curves ◽

The Elderly ◽

Net Benefit ◽

Intensive Care Patients ◽

Saps Ii ◽

Saps Ii Score ◽

Net Benefits

AbstractSeveral commonly used scoring systems (SOFA, SAPS II, LODS, and SIRS) are currently lacking large sample data to confirm the predictive value of 30-day mortality from sepsis, and their clinical net benefits of predicting mortality are still inconclusive. The baseline data, LODS score, SAPS II score, SIRS score, SOFA score, and 30-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) intensive care unit (ICU) database. Receiver operating characteristic (ROC) curves and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits between the four scoring systems and 30-day mortality of sepsis. For all cases in the cohort study, the AUC of LODS, SAPS II, SIRS, SOFA were 0.733, 0.787, 0.597, and 0.688, respectively. The differences between the scoring systems were statistically significant (all P-values < 0.0001), and stratified analyses (the elderly and non-elderly) also showed the superiority of SAPS II among the four systems. According to the DCA, the net benefit ranges in descending order were SAPS II, LODS, SOFA, and SIRS. For stratified analyses of the elderly or non-elderly groups, the results also showed that SAPS II had the most net benefit. Among the four commonly used scoring systems, the SAPS II score has the highest predictive value for 30-day mortality from sepsis, which is better than LODS, SIRS, and SOFA. The results of the DCA curves show that using the SAPS II score to predict the 30-day mortality of intensive care patients with sepsis to guide clinical applications may obtain the highest net benefit.

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