Common intensive care scoring systems do not outperform age and glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

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dc.contributor.author Fallenius, Marika
dc.contributor.author Skrifvars, Markus B.
dc.contributor.author Reinikainen, Matti
dc.contributor.author Bendel, Stepani
dc.contributor.author Raj, Rahul
dc.date.accessioned 2017-11-14T11:02:04Z
dc.date.available 2017-11-14T11:02:04Z
dc.date.issued 2017-10-25
dc.identifier.citation Fallenius , M , Skrifvars , M B , Reinikainen , M , Bendel , S & Raj , R 2017 , ' Common intensive care scoring systems do not outperform age and glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit ' , Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , vol. 24 , 102 . https://doi.org/10.1186/s13049-017-0448-z
dc.identifier.other PURE: 93680243
dc.identifier.other PURE UUID: 6acc51be-a5f8-438d-871c-ca1289874d00
dc.identifier.other WOS: 000413762100001
dc.identifier.other Scopus: 85032193815
dc.identifier.other ORCID: /0000-0002-9759-5738/work/44718200
dc.identifier.uri http://hdl.handle.net/10138/228535
dc.description.abstract Background: Intensive care scoring systems are widely used in intensive care units (ICU) around the world for case-mix adjustment in research and benchmarking. The aim of our study was to investigate the usefulness of common intensive care scoring systems in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage (ICH) treated in intensive care units (ICU). Methods: We performed a retrospective observational study including adult patients with spontaneous ICH treated in Finnish ICUs during 2003-2012. We used six-month mortality as the primary outcome of interest. We used logistic regression to customize Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) for six-month mortality prediction. To assess the usefulness of the scoring systems, we compared their discrimination and calibration with two simpler models consisting of age, Glasgow Coma Scale (GCS) score, and premorbid functional status. Results: Totally 3218 patients were included. Overall six-month mortality was 48%. APACHE II and SAPS II outperformed SOFA (area under the receiver operator curve [AUC] 0.83 and 0.84, respectively, vs. 0.73) but did not show any benefit over the simpler models in terms of discrimination (AUC 0.84, p > 0.05 for all models). SAPS II showed satisfactory calibration (p = 0.058 in the Hosmer-Lemeshow test), whereas all other models showed poor calibration (p <0.05). Discussion: In this retrospective multi-center study, we found that SAPS II and APACHE II were of no additional prognostic value to a simple model based on only age and GCS score for patients with ICH treated in the ICU. In fact, the major predictive ability of APACHE II and SAPS II comes from their age and GCS score components. SOFA performed significantly poorer than the other models and is not applicable as a prognostic model for ICH patients. All models displayed poor calibration, highlighting the need for improved prognostic models for ICH patients. Conclusion: The common intensive care scoring systems did not outperform a simpler model based on only age and GCS score. Thus, the use of previous intensive care scoring systems is not warranted in ICH patients. en
dc.format.extent 9
dc.language.iso eng
dc.relation.ispartof Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject Intracerebral hemorrhage
dc.subject Hemorrhagic stroke
dc.subject Intensive care
dc.subject Outcome
dc.subject Prognosis
dc.subject Apache ii
dc.subject Saps ii
dc.subject Sofa
dc.subject Glasgow coma scale score
dc.subject Age
dc.subject CRITICALLY-ILL PATIENTS
dc.subject APACHE-II
dc.subject SEVERITY
dc.subject MODELS
dc.subject PERFORMANCE
dc.subject CALIBRATION
dc.subject STRATEGIES
dc.subject ILLNESS
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.title Common intensive care scoring systems do not outperform age and glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit en
dc.type Article
dc.contributor.organization Anestesiologian yksikkö
dc.contributor.organization Clinicum
dc.contributor.organization University of Helsinki
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.contributor.organization HUS Perioperative, Intensive Care and Pain Medicine
dc.contributor.organization HUS Neurocenter
dc.contributor.organization Neurokirurgian yksikkö
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1186/s13049-017-0448-z
dc.relation.issn 1757-7241
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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