A new risk prediction model for critical care: The Intensive Care National Audit & Research Centre (ICNARC) model*

Abstract

The ICNARC model demonstrated better discrimination and overall fit than existing risk prediction models, even following recalibration of these models. We recommend it be used to replace previously published models for risk adjustment in the UK.

Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS

“…The following family member characteristics were described by mean and SD, median and quartiles, or number and percentage for all family members included in the final analysis, stratified by the patient's ICU outcome (alive/dead): age in years; age group (< 30 years, The following patient characteristics were described by mean and SD, median and quartiles, or number and percentage for patients with a family member included in the final analysis, stratified by the patient's ICU outcome (alive/dead): age in years; age group (< 30 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, ≥ 80 years); sex; ethnicity (white, Asian or Asian British, black or black British, mixed ethnicity or other ethnic group); deprivation (quintiles, defined as for the family members); distance from home address to hospital (defined as for the family members); severe chronic conditions in the past medical history (liver, renal, respiratory, cardiovascular, metastatic cancer, haematological malignancy, immunocompromise -defined according to APACHE II 26 ); prior dependency (able to live without assistance in daily activities, either minor or major assistance with daily activities, total assistance with daily activities); surgical status (planned admission direct from theatre following elective or scheduled surgery, unplanned admission direct from theatre following surgery of any urgency, non-surgical); ICNARC physiology score 27 (mean and SD); APACHE II score 26 (mean and SD); ICU length of stay (median and quartiles); receipt (number and percentage) and duration (median and quartiles in calendar days) of organ support in the ICU (advanced respiratory support, advanced cardiovascular support, renal support, neurological support); and, for ICU survivors, whether or not the patient died before ultimate discharge from acute hospital.…”

“…¢ Acute Physiology and Chronic Health Evaluation (APACHE) II score and predicted risk of hospital death 26 ¢ ICNARC physiology score and predicted risk of hospital death 27 (note: raw physiology data are submitted to ICNARC and the scores and predicted risk of hospital death are calculated centrally using standard algorithms to avoid any bias) ¢ source of admission to the ICU ¢ location immediately prior to the source of admission [note: if either of these is theatre and recovery in the hospital housing the ICU, data are collected on the type of surgery (elective or emergency) using the classification of the National Confidential Enquiry into Perioperative Deaths] l outcomes:…”

“…These patients were less sick and would have had a shorter length of stay in the ICU and therefore less opportunity for family members to be recruited. The number of family members recruited per patient was generally higher with increasing severity of illness, based on the ICNARC physiology score and predicted risk of death, 27 as these patients tend to stay longer in the ICU, thereby providing greater opportunity for family members to be recruited. However, patients who did not survive the ICU were less likely to have had a family member recruited (43.1%) than patients who survived the ICU (51.6%) (see Table 12), suggesting that family members of the sickest patients were less likely to have been approached.…”

“…Patients with a family member included in the initial psychometric assessment were described by their age in years (mean with SD, and number and percentage by decade of age), sex, surgical status (elective/ scheduled surgery, emergency/urgent surgery or non-surgical), ICNARC physiology score (mean and SD), 27 APACHE II score (mean and SD), 26 ICU outcome (alive or dead) and ICU length of stay (median and quartiles for survivors and non-survivors). Family members included in the initial psychometric assessment were described by their age in years (mean with SD, and number and percentage by decade of age), sex and relationship to the patient (partner, parent, child, sibling, other relative or other non-relative).…”

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

“…Differences in the primary outcome (30-day mortality) were analysed by age (in quartiles), degree of malnutrition (high/moderate or none), acute severity of illness (APACHE II 34 and ICNARC model 35 predicted risk of mortality -in quartiles), mechanical ventilation at admission to the critical care unit, presence of cancer and time from critical care unit admission to commencement of nutritional support (< 24 hours vs. ≥ 24 hours).…”