Unidade de Cuidados Intensivos Polivalente, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal.
Intensive Care Med. 2010 Jul;36(7):1207-12. doi: 10.1007/s00134-010-1852-2. Epub 2010 Mar 20.
To develop a new method to evaluate the performance of individual ICUs through the calculation and visualisation of risk profiles.
The study included 102,561 patients consecutively admitted to 77 ICUs in Austria. We customized the function which predicts hospital mortality (using SAPS II) for each ICU. We then compared the risks of hospital mortality resulting from this function with the risks which would be obtained using the original function. The derived risk ratio was then plotted together with point-wise confidence intervals in order to visualise the individual risk profile of each ICU over the whole spectrum of expected hospital mortality.
We calculated risk profiles for all ICUs in the ASDI data set according to the proposed method. We show examples how the clinical performance of ICUs may depend on the severity of illness of their patients. Both the distribution of the Hosmer-Lemeshow goodness-of-fit test statistics and the histogram of the corresponding P values demonstrated a good fit of the individual risk models.
Our risk profile model makes it possible to evaluate ICUs on the basis of the specific risk for patients to die compared to a reference sample over the whole spectrum of hospital mortality. Thus, ICUs at different levels of severity of illness can be directly compared, giving a clear advantage over the use of the conventional single point estimate of the overall observed-to-expected mortality ratio.
通过计算和可视化风险概况，开发一种评估个体 ICU 性能的新方法。
该研究纳入了奥地利 77 家 ICU 连续收治的 102561 名患者。我们为每个 ICU 定制了预测医院死亡率的 SAPS II 函数。然后，我们比较了该函数预测的医院死亡率风险与原始函数得到的风险。然后，将得出的风险比与逐点置信区间一起绘制，以可视化每个 ICU 在整个预期医院死亡率范围内的个体风险概况。
我们根据提出的方法计算了 ASDI 数据集中所有 ICU 的风险概况。我们展示了 ICU 临床性能如何取决于患者疾病严重程度的示例。Hosmer-Lemeshow 拟合优度检验统计量的分布和相应 P 值的直方图均表明个体风险模型拟合良好。
我们的风险概况模型使得能够根据患者与参考样本相比在整个医院死亡率范围内死亡的特定风险来评估 ICU。因此，可以直接比较不同严重程度的 ICU，这与使用常规的总体观察到的预期死亡率比值的单点估计相比具有明显优势。
