Prediction of Risk of Death Using 30-Day Outcome: A Practical End Point for Quality Auditing in Intensive Care

Graham, Petra L. and Cook, David A. (2004) Prediction of Risk of Death Using 30-Day Outcome: A Practical End Point for Quality Auditing in Intensive Care. Chest, 125 4: 1458-1466. doi:10.1378/chest.125.4.1458


Author Graham, Petra L.
Cook, David A.
Title Prediction of Risk of Death Using 30-Day Outcome: A Practical End Point for Quality Auditing in Intensive Care
Journal name Chest   Check publisher's open access policy
ISSN 0012-3692
Publication date 2004-01-01
Sub-type Article (original research)
DOI 10.1378/chest.125.4.1458
Open Access Status Not yet assessed
Volume 125
Issue 4
Start page 1458
End page 1466
Total pages 13
Place of publication Chicago, Ill
Publisher American College of Chest Physicians
Language eng
Subject 110310 Intensive Care
010401 Applied Statistics
Abstract Study objective: To validate the APACHE (acute physiology and chronic health evaluation) III unadjusted and similar hospital mortality estimate models on 30-day mortality, and to propose a simple approach to modeling local 30-day in-hospital mortality of critically ill hospitalized adults for quality management and risk-adjusted monitoring. Design: Noninterventional, observational study. Patients: A total of 5,278 consecutive eligible hospital admissions between January 1, 1995, and December 31, 1999. Measurements: Prospective collection of demographic, diagnostic, physiologic, laboratory, and hospital admission and discharge data. Results: The APACHE III mortality predictions exhibited excellent discrimination (receiver operating characteristic [ROC] curve area) for 30-day outcome (ROC area, 0.89) and hospital outcome (ROC area, 0.89). Calibration curves and Hosmer-Lemeshow statistics demonstrated good calibration of all models on 30-day outcome, except for the unadjusted APACHE III model. New, simplified risk adjustment models showed good discrimination and calibration on development and test data. ROC areas were 0.88 (developmental data) and 0.87 (test data), and the new model calibration was equivalent to the APACHE III model. Conclusion: For quality audit, 30-day in-hospital mortality can be used as an alternative outcome to survival to hospital discharge. New logistic regression models provide evidence that local models, possessing good calibration and discrimination, may be built from a few explanatory variables.
Keyword Logistic regression
Quality monitoring
Risk adjustment
Risk assessment
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Wed, 01 Apr 2009, 01:42:50 EST by Sophie Jordan on behalf of Anaesthesiology and Critical Care - PAH