Comparison of risk prediction scoring systems for ward patients: a retrospective nested case control study.
Crit Care. 2014 Jun 26;18(3):R132
Authors: Yu S, Leung S, Heo M, Soto GJ, Shah RT, Gunda S, Gong MN
INTRODUCTION: The rising prevalence of rapid response teams have led to a subsequent demand for risk-stratification tools that can estimate a ward patient's risk of clinical deterioration and subsequent need for ICU admission. Finding such a risk-stratification tool is crucial for maximizing the utility of rapid response teams. This study compares the ability of nine risk prediction scores in detecting clinical deterioration among non-ICU ward patients. We also measured each score serially to characterize how these scores changed with time.
METHODS: In a retrospective nested case-control study, we calculated nine well-validated prediction scores for 328 cases and 328 matched controls. Our cohort included non-ICU ward patients admitted to the hospital with a diagnosis of infection, and cases were patients in this cohort who experienced clinical deterioration, defined as requiring a critical care consult, ICU admission, or death. We then compared each prediction score's ability, over 72 hours, to discriminate between cases and controls.
RESULTS: At 0 to 12 hours before clinical deterioration, seven of the eight scores performed with acceptable discrimination (Sequential Organ Failure Assessment Score (SOFA) area under the curve 0.78, Predisposition/Infection/Response/Organ Dysfunction Score 0.76, Vitalpac Early Warning Score 0.75, Simple Clinical Score 0.74, Mortality in Emergency Department Sepsis 0.74, Modified Early Warning Score 0.73, Simplified Acute Physiology Score II 0.73, Acute Physiology and Chronic Health Evaluation II 0.72, and Rapid Emergency Medicine Score 0.67). By measuring scores over time, it was found that average SOFA scores of cases increased as early as 24 to 48 hours prior to deterioration (P = 0.01). Finally, a clinical prediction rule which also accounted for the change in SOFA was constructed and found to perform with a sensitivity of 75% and specificity of 72%, which is better than any SOFA scoring model based on a single set of physiologic variables.
CONCLUSIONS: ICU and emergency room-based prediction scores can also be used to prognosticate risk of clinical deterioration for non-ICU ward patients. In addition, scoring models that take advantage of a score's change over time may have increased prognostic value over models that utilize only a single set of physiologic measurements.
PMID: 24970344 [PubMed - as supplied by publisher]