David N Hager1, Varshitha Tanykonda2, Zeba Noorain2, Sarina K Sahetya3, Catherine E Simpson4, Juan Felipe Lucena5, Dale M Needham6. 1. Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: dhager1@jhmi.edu. 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. Electronic address: ssahety1@jhmi.edu. 4. Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: catherine.simpson@jhmi.edu. 5. Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clinica Universidad de Navarra, Pamplona, Navarra, Spain. Electronic address: flucena@unav.es. 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. Electronic address: dale.needham@jhmi.edu.
Abstract
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.
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.
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