Scientific publications

Hospital mortality prediction for intermediate care patients: Assessing the generalizability of the Intermediate Care Unit Severity Score (IMCUSS)

Hager DN (1), Tanykonda V (2), Noorain Z (2), Sahetya SK (3), Simpson CE (4), Lucena JF (5), Needham DM (6).

(1) Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
(2) Bangalore Medical College and Research Institute, Bangalore, India.
(3) Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
(4) Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
(5) Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.
(6) Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States; Armstrong Institute for Patient Safety, John Hopkins University, Baltimore, MD, United States; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, United States; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.

Magazine: Journal of Critical Care

Date: May 19, 2018

Internal Medicine [SP]

PURPOSE:

The Intermediate Care Unit Severity Score (IMCUSS) is an easy to calculate predictor of in-hospital death, and the only such tool developed for patients in the intermediate care setting. We sought to examine its external validity.

MATERIALS AND METHODS:

Using data from patients admitted to the intermediate care unit (IMCU) of an urban academic medical center from July to December of 2012, model discrimination and calibration for predicting in-hospital death were assessed using the area under the receiver operating characteristic (AUROC) and the Hosmer-Lemeshow goodness-of-fit chi-squared (HL GOF X2) test, respectively. The standardized mortality ratio (SMR) with 95% confidence intervals (95% CI) was also calculated.

RESULTS:

The cohort included data from 628 unique admissions to the IMCU. Overall hospital mortality was 8.3%. The median IMCUSS was 10 (Interquartile Range: 0-16), with 229 (36%) patients having a score of zero. The AUROC for the IMCUSS was 0.72 (95% CI: 0.64-0.78), the HL GOF X2 = 30.7 (P < 0.001), and the SMR was 1.22 (95% CI: 0.91-1.60).

CONCLUSIONS:

The IMCUSS exhibited acceptable discrimination, poor calibration, and underestimated mortality. Other centers should assess the performance of the IMCUSS before adopting its use.

CITATION  J Crit Care. 2018 Aug;46:94-98. doi: 10.1016/j.jcrc.2018.05.009. Epub 2018 May 19

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