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Mortality prediction models in the adult critically ill: A scoping review.

Abstract：

BACKGROUND:Mortality prediction models are applied in the intensive care unit (ICU) to stratify patients into different risk categories and to facilitate benchmarking. To ensure that the correct prediction models are applied for these purposes, the best performing models must be identified. As a first step, we aimed to establish a systematic review of mortality prediction models in critically ill patients. METHODS:Mortality prediction models were searched in four databases using the following criteria: developed for use in adult ICU patients in high-income countries, with mortality as primary or secondary outcome. Characteristics and performance measures of the models were summarized. Performance was presented in terms of discrimination, calibration and overall performance measures presented in the original publication. RESULTS:In total, 43 mortality prediction models were included in the final analysis. In all, 15 models were only internally validated (35%), 13 externally (30%) and 10 (23%) were both internally and externally validated by the original researchers. Discrimination was assessed in 42 models (98%). Commonly used calibration measures were the Hosmer-Lemeshow test (60%) and the calibration plot (28%). Calibration was not assessed in 11 models (26%). Overall performance was assessed in the Brier score (19%) and the Nagelkerke's R2 (4.7%). CONCLUSIONS:Mortality prediction models have varying methodology, and validation and performance of individual models differ. External validation by the original researchers is often lacking and head-to-head comparisons are urgently needed to identify the best performing mortality prediction models for guiding clinical care and research in different settings and populations.

journal_name

Acta Anaesthesiol Scand

journal_title

Acta anaesthesiologica Scandinavica

authors

Keuning BE,Kaufmann T,Wiersema R,Granholm A,Pettilä V,Møller MH,Christiansen CF,Castela Forte J,Snieder H,Keus F,Pleijhuis RG,van der Horst ICC,HEALICS consortium.

doi

10.1111/aas.13527

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

424-442

issue

eissn

0001-5172

issn

1399-6576

journal_volume

pub_type

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Mortality prediction models in the adult critically ill: A scoping review.