TY - JOUR
T1 - Specificity and reliability of prognostic indexes in intensive care evaluation
T2 - The spontaneous cerebral haemorrhage case
AU - Barbieri, Alberto
AU - Pinna, Cristina
AU - Basso, Gian Paolo
AU - Molinari, Rosella
AU - Giuliani, Enrico
AU - Fruggeri, Luca
AU - Nolli, Massimo
PY - 2009/4
Y1 - 2009/4
N2 - Objective To determine the reliability of a generic index such as Simplified Acute Physiology Score II (SAPSII), compared with a specific one Intra Cerebral Haemorrhage score (ICH score), as an intensive care unit (ICU) outcome predictor when evaluating a general facility that frequently treats a specific type of patients - those with spontaneous cerebral haemorrhage. Methods The study cohort consisted of a random sample of patients (81) admitted to Modena's Policlinico Teaching Hospital's ICU with spontaneous ICH over a 24-month period. Main outcome measure SAPSII, ICH score, overall mortality. Results The mean ICH score for the 32 surviving patients was 3.41 ± 1.012 while for the 49 deceased patients was of 4.24 ± 0.855 (P = 0.000). The mean SAPSII value for the 32 surviving patients was 49.09 ± 16.58 while for the 49 deceased patients was 49.51 ± 15.93. SAPSII, ICH scores were analysed for mortality, by receiver operating characteristic curves: the area under the curve was significant for ICH, not-significant for SAPSII. Conclusions Regional quality controls use generic prognostic indexes (SAPSII) in relation to mortality and outcome to assess ICUs, which is appropriate when dealing with a general facility when there is not a predominant type of patient, but it may bias the evaluation if the population with specific pathologies (ICH), not included in the general index, is statistically considerable, leading to an incorrect criticality assessment, an inappropriate strategic plan and the subsequent inefficient resource allocation.
AB - Objective To determine the reliability of a generic index such as Simplified Acute Physiology Score II (SAPSII), compared with a specific one Intra Cerebral Haemorrhage score (ICH score), as an intensive care unit (ICU) outcome predictor when evaluating a general facility that frequently treats a specific type of patients - those with spontaneous cerebral haemorrhage. Methods The study cohort consisted of a random sample of patients (81) admitted to Modena's Policlinico Teaching Hospital's ICU with spontaneous ICH over a 24-month period. Main outcome measure SAPSII, ICH score, overall mortality. Results The mean ICH score for the 32 surviving patients was 3.41 ± 1.012 while for the 49 deceased patients was of 4.24 ± 0.855 (P = 0.000). The mean SAPSII value for the 32 surviving patients was 49.09 ± 16.58 while for the 49 deceased patients was 49.51 ± 15.93. SAPSII, ICH scores were analysed for mortality, by receiver operating characteristic curves: the area under the curve was significant for ICH, not-significant for SAPSII. Conclusions Regional quality controls use generic prognostic indexes (SAPSII) in relation to mortality and outcome to assess ICUs, which is appropriate when dealing with a general facility when there is not a predominant type of patient, but it may bias the evaluation if the population with specific pathologies (ICH), not included in the general index, is statistically considerable, leading to an incorrect criticality assessment, an inappropriate strategic plan and the subsequent inefficient resource allocation.
KW - Intensive care
KW - Prognostic indexes
KW - Quality assessment
KW - Spontaneous intraparenchimal cerebral haemorrhage
UR - http://www.scopus.com/inward/record.url?scp=62849104840&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=62849104840&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2753.2008.00988.x
DO - 10.1111/j.1365-2753.2008.00988.x
M3 - Article
C2 - 19335479
AN - SCOPUS:62849104840
VL - 15
SP - 242
EP - 245
JO - Journal of Evaluation in Clinical Practice
JF - Journal of Evaluation in Clinical Practice
SN - 1356-1294
IS - 2
ER -