Evaluación de la reproducibilidad de la recogida de datos para el APACHE II, APACHE III adaptado para España y SAPS II en 9 Unidades de Cuidados Intensivos en España

Domínguez, Luis; Enríquez, Pedro; Álvarez, Pablo; Frutos, M. De; Sagredo, Víctor; López-Messa, J.B.; Carriedo, Demetrio; Taboada, Francisco; García-Labattut, Á.; Gandía, Francisco; Valledor, M.; Blanco, Jesús

doi:10.1016/s0210-5691(08)70898-2

“…A further advantage of an automated index is the reduction in inter-observer variability, which can influence mortality prediction. 33 Our intention was not to replace existing indexes, 1---9 since the manual collection of data on the degree and duration of these alterations implies a heavier work load. However, these routinely collected data appear to offer similar information to that provided by these systems, and future technological developments may vastly reduce the work involved in constructing this new type of index.…”

Section: Most Frequent Diagnosesmentioning

confidence: 99%

Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

Rivera-Fernández

¹

,

Castillo-Lorente

²

,

Nap

³

et al. 2012

Medicina Intensiva (English Edition)

0

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Objective: To test the hypothesis that the degree and duration of alterations in physiological variables routinely gathered by intensive care unit (ICU) monitoring systems during the first day of admission to the ICU, together with a few additional routinely recorded data, yield information similar to that obtained by traditional mortality prediction systems. Design: A prospective observational multicenter study (EURICUS II) was carried out. Setting: Fifty-five European ICUs. Patients: A total of 17,598 consecutive patients admitted to the ICU over a 10-month period. Interventions: None. Main variables of interest:Hourly data were manually gathered on alterations or ''events'' in systolic blood pressure, heart rate and oxygen saturation throughout ICU stay to construct an events index and mortality prediction models. Results: The mean first-day events index was 6.37 ± 10.47 points, and was significantly associated to mortality (p < 0.001), with a discrimination capacity for hospital mortality of 0.666 (area under the ROC curve). A second index included this first-day events index, age, preadmission location, and the Glasgow coma score. A model constructed with this second index plus diagnosis upon admission was validated by using the Jackknife method (Hosmer-Lemeshow, H = 13.8554, insignificant); the area under ROC curve was 0.818. Conclusions: A prognostic index with performance very similar to that of habitual systems can be constructed from routine ICU data with only a few patient characteristics. These results may serve as a guide for the possible automated construction of ICU prognostic indexes. © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved. * Corresponding author. E-mail address: encarnacion.castillo.sspa@juntadeandalucia.es (E. Castillo-Lorente). Relationship between mortality and first-day events index 635 PALABRAS CLAVE Cuidados Intensivos; Cuidados Críticos; Índices de gravedad; EventosRelación entre la mortalidad y el índice de eventos del primer día de estancia a partir de variables fisiológicas recogidas durante la monitorización rutinaria de pacientes de la UCI Resumen Objetivo: Comprobar si el grado y duración de las alteraciones en las variables fisiológicas recogidas en la monitorización rutinaria en UCI durante el primer día de estancia, junto con pocos datos adicionales, proporcionan información similar a la obtenida con los sistemas tradicionales de predicción de mortalidad. Diseño: Estudio observacional, prospectivo y multicéntrico (EURICUS-II). Ámbito: 55 UCIs de Europa. Pacientes: 17.598 pacientes consecutivos, ingresados durante 10 meses. Intervenciones: ninguna. Variables de interés principales: se recogieron manualmente datos horarios sobre alteraciones o ''eventos'' en la presión arterial sistólica, frecuencia cardiaca y saturación de oxígeno, para construir un índice basado en estos eventos y un modelo de predicción de mortalidad. Resultados: El índice de eventos el primer día fue 6,37 ± 10,47 puntos y se asoció significativamente con la mortalidad (p < 0,001)...

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“…Sr. Director: He leído con interés los dos estudios publicados recientemente en Medicina Intensiva por Domínguez et al sobre la efectividad y la eficiencia en las unidades de cuidados intensivos (UCI) 1 y sobre la reproducibilidad de las distintas puntuaciones de ajuste de riesgo (APACHE II, APACHE III y SAPS II) 2 . Ambos casos ponen de manifiesto el alto nivel de la revista que usted dirige y de los investigadores que en ella publican.…”

Section: Sobre La Calibración De Los Sistemas De Predicción De Muerteunclassified

Sobre la calibración de los sistemas de predicción de muerte en los pacientes críticos

Herrejón

¹

2009

Medicina Intensiva

0

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Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

Rivera-Fernández

¹

,

Castillo-Lorente

²

,

Nap³

et al. 2012

View full text Add to dashboard Cite

Objective: To test the hypothesis that the degree and duration of alterations in physiological variables routinely gathered by intensive care unit (ICU) monitoring systems during the first day of admission to the ICU, together with a few additional routinely recorded data, yield information similar to that obtained by traditional mortality prediction systems. Design: A prospective observational multicenter study (EURICUS II) was carried out. Setting: Fifty-five European ICUs. Patients: A total of 17,598 consecutive patients admitted to the ICU over a 10-month period. Interventions: None. Main variables of interest:Hourly data were manually gathered on alterations or ''events'' in systolic blood pressure, heart rate and oxygen saturation throughout ICU stay to construct an events index and mortality prediction models. Results: The mean first-day events index was 6.37 ± 10.47 points, and was significantly associated to mortality (p < 0.001), with a discrimination capacity for hospital mortality of 0.666 (area under the ROC curve). A second index included this first-day events index, age, preadmission location, and the Glasgow coma score. A model constructed with this second index plus diagnosis upon admission was validated by using the Jackknife method (Hosmer-Lemeshow, H = 13.8554, insignificant); the area under ROC curve was 0.818. Conclusions: A prognostic index with performance very similar to that of habitual systems can be constructed from routine ICU data with only a few patient characteristics. These results may serve as a guide for the possible automated construction of ICU prognostic indexes. © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved. * Corresponding author. E-mail address: encarnacion.castillo.sspa@juntadeandalucia.es (E. Castillo-Lorente). Relationship between mortality and first-day events index 635 PALABRAS CLAVE Cuidados Intensivos; Cuidados Críticos; Índices de gravedad; EventosRelación entre la mortalidad y el índice de eventos del primer día de estancia a partir de variables fisiológicas recogidas durante la monitorización rutinaria de pacientes de la UCI Resumen Objetivo: Comprobar si el grado y duración de las alteraciones en las variables fisiológicas recogidas en la monitorización rutinaria en UCI durante el primer día de estancia, junto con pocos datos adicionales, proporcionan información similar a la obtenida con los sistemas tradicionales de predicción de mortalidad. Diseño: Estudio observacional, prospectivo y multicéntrico (EURICUS-II). Ámbito: 55 UCIs de Europa. Pacientes: 17.598 pacientes consecutivos, ingresados durante 10 meses. Intervenciones: ninguna. Variables de interés principales: se recogieron manualmente datos horarios sobre alteraciones o ''eventos'' en la presión arterial sistólica, frecuencia cardiaca y saturación de oxígeno, para construir un índice basado en estos eventos y un modelo de predicción de mortalidad. Resultados: El índice de eventos el primer día fue 6,37 ± 10,47 puntos y se asoció significativamente con la mortalidad (p < 0,001)...

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Evaluación de la reproducibilidad de la recogida de datos para el APACHE II, APACHE III adaptado para España y SAPS II en 9 Unidades de Cuidados Intensivos en España

Abstract: In this study, APS was the most influential factor on the reproducibility of severity scores and risk of death prediction. Admission diagnosis assignment had no significant impact on the reproducibility of the predicted mortality risk.

Cited by 6 publications

References 24 publications

Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

Sobre la calibración de los sistemas de predicción de muerte en los pacientes críticos

Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

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