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Intensive Care Medicine
Published in: Intensive Care Medicine 11/2013

01-11-2013 | Original

Prediction of long-term mortality in ICU patients: model validation and assessing the effect of using in-hospital versus long-term mortality on benchmarking

Authors: Sylvia Brinkman, Ameen Abu-Hanna, Evert de Jonge, Nicolette F. de Keizer

Published in: Intensive Care Medicine | Issue 11/2013

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Abstract

Purpose

To analyze the influence of using mortality 1, 3, and 6 months after intensive care unit (ICU) admission instead of in-hospital mortality on the quality indicator standardized mortality ratio (SMR).

Methods

A cohort study of 77,616 patients admitted to 44 Dutch mixed ICUs between 1 January 2008 and 1 July 2011. Four Acute Physiology and Chronic Health Evaluation (APACHE) IV models were customized to predict in-hospital mortality and mortality 1, 3, and 6 months after ICU admission. Models’ performance, the SMR and associated SMR rank position of the ICUs were assessed by bootstrapping.

Results

The customized APACHE IV models can be used for prediction of in-hospital mortality as well as for mortality 1, 3, and 6 months after ICU admission. When SMR based on mortality 1, 3 or 6 months after ICU admission was used instead of in-hospital SMR, 23, 36, and 30 % of the ICUs, respectively, received a significantly different SMR. The percentages of patients discharged from ICU to another medical facility outside the hospital or to home had a significant influence on the difference in SMR rank position if mortality 1 month after ICU admission was used instead of in-hospital mortality.

Conclusions

The SMR and SMR rank position of ICUs were significantly influenced by the chosen endpoint of follow-up. Case-mix-adjusted in-hospital mortality is still influenced by discharge policies, therefore SMR based on mortality at a fixed time point after ICU admission should preferably be used as a quality indicator for benchmarking purposes.
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Metadata
Title
Prediction of long-term mortality in ICU patients: model validation and assessing the effect of using in-hospital versus long-term mortality on benchmarking
Authors
Sylvia Brinkman
Ameen Abu-Hanna
Evert de Jonge
Nicolette F. de Keizer
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 11/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-3042-5

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