Abstract:
OBJECTIVE:To compare the impact of two different customization strategies in the performance of the admission Mortality Probability Model II (MPM II0) using formal statistical assessment. DESIGN:Analysis of the database of a multicenter, multinational, prospective cohort study, EURICUS-1, involving 89 intensive care units (ICUs) from 12 European countries. SETTING:Eighty-nine ICUs from 12 European countries. PATIENTS:Data from 16,060 patients consecutively admitted to 89 ICUs from 12 European countries were collected during a 4-month period. In accordance with original MPM II0 criteria, the following patients were excluded from analysis: patients <18 yrs of age; patients considered readmissions; patients with acute myocardial infarction or burns; and patients in the postoperative period recovering from coronary artery bypass surgery. A total of 10,397 patients were analyzed. INTERVENTIONS:Collection of the data necessary for the calculation of MPM II0 and basic demographic statistics. Vital status at hospital discharge was registered. Two new logistic regression equations were developed to relate MPM II0 to mortality after splitting the database into development and validation samples, the first with the original logit of MPM II0 as an independent variable (first-level customization), and the second with all 15 original variables (second-level customization). Discrimination (area under the receiver operating curve), Hosmer-Lemeshow goodness-of-fit tests H and C, and observed/expected mortality ratios were evaluated in both samples and within relevant subgroups. MEASUREMENTS AND MAIN RESULTS:The discriminative capability of the models was only slightly affected by customization (0.810 vs. 0.803), remaining lower than in the original description of the MPM II0 (0.824). Calibration improved, with Hosmer-Lemeshow goodness-of-fit tests H and C showing a good fit of the models. However, the formal evaluation of discrimination, calibration, and observed/expected mortality ratios across relevant subgroups appeared to be poor in some groups. CONCLUSIONS:In this ICU patient database, second-level customization was more effective than first-level customization in improving the overall goodness-of-fit of MPM II0 and should probably be chosen as the preferential strategy to improve the fit of a model when the sample size is large enough. However, second level customization had only a slight impact on discrimination. Its effects on the uniformity of fit are insufficient to overcome the problems that can arise when the model is applied in populations in which the case-mix is distinct from the population where it was originally developed.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Moreno R,Apolone Gdoi
10.1097/00003246-199712000-00017subject
Has Abstractpub_date
1997-12-01 00:00:00pages
2001-8issue
12eissn
0090-3493issn
1530-0293journal_volume
25pub_type
杂志文章abstract:OBJECTIVE:In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious pr...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.CCM.0000050454.01978.3B
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To compare propofol, methohexital, and midazolam administered as titrated infusions for sedation during electrical cardioversion. DESIGN:A prospective, randomized, single-blind comparative study. SETTING:Coronary care unit in a military teaching hospital. PATIENTS:Thirty adult patients with atrial fibrilla...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199310000-00019
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181a03063
更新日期:2009-07-01 00:00:00
abstract::Many clinical conditions are associated with an increase in abdominal pressure. While the effects on venous return have been studied in the past, little attention has been given to the effect of abdominal pressure on left-sided hemodynamic events. The effects of acute changes in abdominal pressure (Pab) on left ventri...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198510000-00006
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVES:To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN:A retrospective cohort design. SETTING:Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003324
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infecti...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/ccm.0b013e3181b9e8b3
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:The clinical value of stroke volume variations to assess intravascular fluid status in critically ill patients is well known. Electrical impedance tomography is a noninvasive monitoring technology that has been primarily used to assess ventilation. We investigated the potential of electrical impedance tomogra...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182227e65
更新日期:2011-09-01 00:00:00
abstract::Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and servi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181aa6288
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:Cytomegalovirus reactivation may complicate critical illness in latent carriers of the virus, even in patients who were previously immunocompetent. Patients with acute respiratory distress syndrome are considered to be prone for reactivation. Prophylactic antiviral therapy in immunocompetent cytomegalovirus s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000712
更新日期:2015-02-01 00:00:00
abstract::Acute kidney injury (AKI) is commonly and increasingly encountered in patients with critical illness. In the past, epidemiologic studies have consistently found that oliguria further increases the risk of death from AKI. Compared with patients outside the intensive care unit (ICU), critically ill patients are more lik...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318168c92f
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:The Sequential Organ Failure Assessment (SOFA) score was developed to quantify the severity of patients' illness, based on the degree of organ dysfunction. This study aimed to evaluate the accuracy and the reliability of SOFA scoring. DESIGN:Prospective study. SETTING:Adult intensive care unit (ICU) in a te...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000178178.02574.ab
更新日期:2005-09-01 00:00:00
abstract::Traumatic injuries occur in > 20 million children each year and are the leading source of death in children over the age of 1 yr. Mechanisms of injury and subsequent therapies for critically injured children are diverse. This review will focus on resources and management strategies for caring for the severely injured ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200211001-00013
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVE:To assess the possible benefits of sympatholytics on uncontrolled hemorrhage in unanesthetized rats. DESIGN:A randomized laboratory study using rats to test the effects of sympatholytics on uncontrolled hemorrhage. SETTING:Research laboratory. SUBJECTS:Forty female Sprague-Dawley rats, randomly assigned in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00025
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVES:Lung CT is the reference imaging technique for acute respiratory distress syndrome, but requires transportation outside the intensive care and x-ray exposure. Lung ultrasound is a promising, inexpensive, radiation-free, tool for bedside imaging. Aim of the present study was to compare the global and regional...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003971
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVES:To define the role of the intensivist in the initiation and management of patients on extracorporeal membrane oxygenation. DESIGN:Retrospective review of the literature and expert consensus. SETTING:Series of in-person meetings, conference calls, and emails from January 2018 to March 2019. SUBJECTS:A mult...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004330
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVES:Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN:Prospective observational t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002765
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:Several studies have suggested that intravenous hydroxyethyl starch treatment may dampen acute inflammatory responses. It is well documented that limited oxygen delivery to tissues (hypoxia) is common in acute inflammation, and numerous parallels exist between acute responses to hypoxia and to inflammation, i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000218814.77568.BC
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to: 1) describe a newly mechanism of blood flow to the brain during cardiopulmonary resuscitation using the impedance threshold device in a piglet model of cardiac arrest, and 2) describe the survival benefits in humans of applying all of the highly recommended changes in the 2005...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/ccm.0b013e31818a7e56
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:The first 70 years of critical care can be considered a period of "industrial revolution-like" advancement in terms of progressing the understanding and care of critical illness. Unfortunately, like the industrial revolution's impact on the environment, advancing ICU care of increasingly elderly, immunosuppre...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004783
更新日期:2021-02-01 00:00:00
abstract:OBJECTIVE:To compare urea nitrogen removal by continuous hemodiafiltration vs. functional native kidneys in critically ill, septic patients receiving > 2 g of amino acids/kg body weight per day. DESIGN:Prospective, comparative, unblinded study. SETTING:Trauma critical care units of a Level I adult trauma hospital. P...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199403000-00009
更新日期:1994-03-01 00:00:00
abstract:OBJECTIVE:To review the incidence, diagnosis, and management of septic emboli caused by vascular catheters after surgery for congenital heart disease. DESIGN:Retrospective clinical review. All patients were computer registered. Our database includes daily follow-up and every sign of infection registered. SETTING:Pedi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200003000-00039
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the role of continuous lateral rotational therapy on the development of ventilator-associated pneumonia in patients requiring long-term mechanical ventilation. DESIGN:Prospective control study. SETTING:Chronic ventilator unit in tertiary care hospital. METHODS:Thirty-seven patients requiring lo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200209000-00006
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVES:To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. DESIGN:Retrospective cohort analysis. SETTING:Ninety North American PICUs that participated in the Virtual Pediatr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31829eb970
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVES:To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. DESIGN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000322
更新日期:2014-07-01 00:00:00
abstract::PEEP is the most important therapeutic intervention in the management of acute respiratory failure. Transitory PEEP disconnection to perform clinically relevant maneuvers is often necessary, but its effect upon PaO2 and physiological shunt in patients requiring high-level PEEP is not clear from the literature. Nine ad...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197902000-00003
更新日期:1979-02-01 00:00:00
abstract:OBJECTIVE:The flow rate of a liquid drainage from the lungs is limited because of the elastic nature of the airways. This study was designed to clarify the relationship between intrapulmonary liquid volume and the development of the flow limitation or choked flow phenomenon as a function of expiratory flow rate during ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000104918.48411.91
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318180ddf9
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVES:To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population. DESIGN:Prospective observational study. SETTING:Fifteen ICUs worldwide. PATIENTS:Consecutive adult ICU patients with a bladder catheter. INTERVENTIONS:None. MEASUREMENTS AND MAIN...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000003623
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:To determine the cost savings of replacing intravenous midazolam with enterally administered lorazepam in mechanically ventilated children who require long-term continuous sedation. DESIGN:Retrospective review of patients treated according to a preestablished pediatric intensive care unit (ICU) sedation prot...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199902000-00052
更新日期:1999-02-01 00:00:00
abstract::Among Gram-positive pathogens, Staphylococcus aureus is the leading cause of death from nosocomial pneumonia. The bacterium developed progressive resistance to beta-lactams, and methicillin-resistant strains emerged in the 1980s. In consequence, vancomycin has become the drug of choice for treatment of this infection ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200104001-00005
更新日期:2001-04-01 00:00:00