Scoring systems for the critically ill:use, misuse and abuse

Skrobik, Yoanna; Kavanagh, Brian P.

doi:10.1007/bf03022613

Cited by 20 publications

(12 citation statements)

References 18 publications

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“…However, great caution must be exercised, as these models provide robust probabilistic estimates of outcome in groups of patients, but may not accurately predict outcomes in individuals. 22 Therefore, misuse of the models in this way could result in prediction of death becoming a self-fulfilling prophecy.…”

Section: Discussionmentioning

confidence: 99%

External Validation of the CRASH and IMPACT Prognostic Models in Severe Traumatic Brain Injury

Han

King

Neilson

et al. 2014

Journal of Neurotrauma

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An accurate prognostic model is extremely important in severe traumatic brain injury (TBI) for both patient management and research. Clinical prediction models must be validated both internally and externally before they are considered widely applicable. Our aim is to independently externally validate two prediction models, one developed by the Corticosteroid Randomization After Significant Head injury (CRASH) trial investigators, and the other from the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) group. We used a cohort of 300 patients with severe TBI (Glasgow Coma Score [GCS] ≤8) consecutively admitted to the National Neuroscience Institute (NNI), Singapore, between February 2006 and December 2009. The CRASH models (base and CT) predict 14 day mortality and 6 month unfavorable outcome. The IMPACT models (core, extended, and laboratory) estimate 6 month mortality and unfavorable outcome. Validation was based on measures of discrimination and calibration. Discrimination was assessed using the area under the receiving operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow (H-L) goodness-of-fit test and Cox calibration regression analysis. In the NNI database, the overall observed 14 day mortality was 47.7%, and the observed 6 month unfavorable outcome was 71.0%. The CRASH base model and all three IMPACT models gave an underestimate of the observed values in our cohort when used to predict outcome. Using the CRASH CT model, the predicted 14 day mortality of 46.6% approximated the observed outcome, whereas the predicted 6 month unfavorable outcome was an overestimate at 74.8%. Overall, both the CRASH and IMPACT models showed good discrimination, with AUCs ranging from 0.80 to 0.89, and good overall calibration. We conclude that both the CRASH and IMPACT models satisfactorily predicted outcome in our patients with severe TBI.

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Section: Discussionmentioning

confidence: 99%

External Validation of the CRASH and IMPACT Prognostic Models in Severe Traumatic Brain Injury

Han

King

Neilson

et al. 2014

Journal of Neurotrauma

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“…Although physiologic scoring systems were intended to estimate a population's mortality R instead of specific patient outcome, APACHE II has been used to assess disease severity in the individual patient [30]. Current uses include APACHE II as a tool in clinical research to assess equivalence of disease severity along with clinical decision making about administration of novel therapy such as rhAPC in severe sepsis [13,31].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle

Nguyen¹,

Ginkel²,

Batech³

et al. 2012

Journal of Critical Care

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“…55 We would recommend that the models be used as an adjunct to clinical judgement and not to directly guide individual patient clinical decision-making, particularly where this is likely to be of a life-or-death nature, for example withdrawal of life-sustaining therapy. 56 …”

Section: Discussionmentioning

confidence: 99%

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

Harrison

Griggs

Prabhu

et al. 2015

Journal of Neurotrauma

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This study validates risk prediction models for acute traumatic brain injury (TBI) in critical care units in the United Kingdom and recalibrates the models to this population. The Risk Adjustment In Neurocritical care (RAIN) Study was a prospective, observational cohort study in 67 adult critical care units. Adult patients admitted to critical care following acute TBI with a last pre-sedation Glasgow Coma Scale score of less than 15 were recruited. The primary outcomes were mortality and unfavorable outcome (death or severe disability, assessed using the Extended Glasgow Outcome Scale) at six months following TBI. Of 3626 critical care unit admissions, 2975 were analyzed. Following imputation of missing outcomes, mortality at six months was 25.7% and unfavorable outcome 57.4%. Ten risk prediction models were validated from Hukkelhoven and colleagues, the Medical Research Council (MRC) Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators, and the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) group. The model with the best discrimination was the IMPACT ''Lab'' model (C index, 0.779 for mortality and 0.713 for unfavorable outcome). This model was well calibrated for mortality at six months but substantially under-predicted the risk of unfavorable outcome. Recalibration of the models resulted in small improvements in discrimination and excellent calibration for all models. The risk prediction models demonstrated sufficient statistical performance to support their use in research and audit but fell below the level required to guide individual patient decision-making. The published models for unfavorable outcome at six months had poor calibration in the UK critical care setting and the models recalibrated to this setting should be used in future research.

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Scoring systems for the critically ill:use, misuse and abuse

Cited by 20 publications

References 18 publications

External Validation of the CRASH and IMPACT Prognostic Models in Severe Traumatic Brain Injury

External Validation of the CRASH and IMPACT Prognostic Models in Severe Traumatic Brain Injury

Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

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