Elliott Ridgeon1, Rinaldo Bellomo2, John Myburgh3, Manoj Saxena3, Mark Weatherall4, Rahi Jahan5, Dilshan Arawwawala6, Stephanie Bell7, Warwick Butt8, Julie Camsooksai9, Coralie Carle10, Andrew Cheng11, Emanuel Cirstea12, Jeremy Cohen13, Julius Cranshaw14, Anthony Delaney15, Glenn Eastwood16, Suzanne Eliott17, Uwe Franke12, Dashiell Gantner15, Cameron Green18, Richard Howard-Griffin7, Deborah Inskip11, Edward Litton19, Christopher MacIsaac2, Amanda McCairn20, Tushar Mahambrey20, Parvez Moondi21, Lynette Newby22, Stephanie O'Connor23, Claire Pegg24, Alan Pope10, Henrik Reschreiter9, Brent Richards25, Megan Robertson26, Helen Rodgers27, Yahya Shehabi17, Ian Smith28, Julie Smith29, Neil Smith28, Anna Tilsley30, Christina Whitehead31, Emma Willett14, Katherine Wong21, Claudia Woodford32, Stephen Wright33, Paul Young4. 1. Medical Research Institute of New Zealand, Wellington, New Zealand. paul.young@ccdhb.org.nz. 2. University of Melbourne, Melbourne, VIC, Australia. 3. George Institute for Global Health, Sydney, NSW, Australia. 4. Medical Research Institute of New Zealand, Wellington, New Zealand. 5. Intensive Care National Audit and Research Centre, London, United Kingdom. 6. Mid Essex Hospitals NHS Trust, Chelmsford, United Kingdom. 7. Critical Care Unit, Ipswich Hospital NHS Trust, Ipswich, United Kingdom. 8. Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia. 9. Poole Hospital NHS Foundation Trust, Poole, United Kingdom. 10. Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom. 11. St George Hospital, Sydney, NSW, Australia. 12. South Tees NHS Trust, Middlesbrough, United Kingdom. 13. Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 14. Royal Bournemouth Hospital, Bournemouth, United Kingdom. 15. Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia. 16. Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. 17. Intensive Care Unit, Monash Medical Centre, Melbourne, VIC, Australia. 18. Department of Intensive Care Medicine, Frankston Hospital, Melbourne, VIC, Australia. 19. Fiona Stanley Hospital, Perth, WA, Australia. 20. Intensive Care Unit, St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom. 21. Queen Elizabeth Hospital, Kings Lynn, United Kingdom. 22. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. 23. Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia. 24. Medway NHS Foundation Trust, Gillingham, United Kingdom. 25. Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia. 26. St Vincent's Hospital, Melbourne, VIC, Australia. 27. Canberra Hospital, Canberra, ACT, Australia. 28. Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom. 29. Intensive Care Unit, Bendigo Hospital, Bendigo, VIC, Australia. 30. Department of Intensive Care Medicine, Middlemore Hospital, Auckland, New Zealand. 31. Westmead Hospital, Sydney, NSW, Australia. 32. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. 33. Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Abstract
OBJECTIVE: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. DESIGN, SETTING AND PARTICIPANTS: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. MAIN OUTCOME MEASURES: Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). RESULTS: Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% CI, 0.49-0.60), and for proximate cause of death List B, kappa was 0.58 (95% CI, 0.53-0.63). For the underlying cause of death, kappa was 0.48 (95% CI, 0.44-0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%-93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%-92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%-81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. CONCLUSIONS: The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.
OBJECTIVE: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. DESIGN, SETTING AND PARTICIPANTS: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. MAIN OUTCOME MEASURES: Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). RESULTS: Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% CI, 0.49-0.60), and for proximate cause of death List B, kappa was 0.58 (95% CI, 0.53-0.63). For the underlying cause of death, kappa was 0.48 (95% CI, 0.44-0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%-93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%-92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%-81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. CONCLUSIONS: The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.
Authors: Paul Young; Diane Mackle; Rinaldo Bellomo; Michael Bailey; Richard Beasley; Adam Deane; Glenn Eastwood; Simon Finfer; Ross Freebairn; Victoria King; Natalie Linke; Edward Litton; Colin McArthur; Shay McGuinness; Rakshit Panwar Journal: Intensive Care Med Date: 2019-11-20 Impact factor: 17.440
Authors: Mervyn Singer; Paul J Young; John G Laffey; Pierre Asfar; Fabio Silvio Taccone; Markus B Skrifvars; Christian S Meyhoff; Peter Radermacher Journal: Crit Care Date: 2021-12-19 Impact factor: 9.097
Authors: Paul Young; Diane Mackle; Rinaldo Bellomo; Michael Bailey; Richard Beasley; Adam Deane; Glenn Eastwood; Simon Finfer; Ross Freebairn; Victoria King; Natalie Linke; Edward Litton; Colin McArthur; Shay McGuinness; Rakshit Panwar Journal: Intensive Care Med Date: 2020-08-18 Impact factor: 17.440