Department of Medical Informatics, Academic Medical Center, Room J1b-124, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Intensive Care Med. 2011 Aug;37(8):1258-68. doi: 10.1007/s00134-011-2265-6. Epub 2011 Jun 7.
To systematically review prognostic research literature on development and/or validation of mortality predictive models in elderly patients.
We searched the Scopus database until June 2010 for articles aimed at validating prognostic models for survival or mortality in elderly intensive care unit (ICU) patients. We assessed the models' fitness for their intended purpose on the basis of barriers for use reported in the literature, using the following categories: (1) clinical credibility, (2) methodological quality (based on an existing quality assessment framework), (3) external validity, (4) model performance, and (5) clinical effectiveness.
Seven studies were identified which met our inclusion criteria, one of which was an external validation study. In total, 17 models were found of which six were developed for the general adult ICU population and eleven specifically for elderly patients. Cohorts ranged from 148 to 12,993 patients and only smaller ones were obtained prospectively. The area under the receiver operating characteristic curve (AUC) was most commonly used to measure performance (range 0.71-0.88). The median number of criteria met for clinical credibility was 4.5 out of 7 (range 2.5-5.5) and 17 out of 20 for methodological quality (range 15-20).
Although the models scored relatively well on methodological quality, none of them can be currently considered sufficiently credible or valid to be applicable in clinical practice for elderly patients. Future research should focus on external validation, addressing performance measures relevant for their intended use, and on clinical credibility including the incorporation of factors specific for the elderly population.
系统评价老年患者生存或死亡率预测模型的开发和/或验证的预后研究文献。
我们在 Scopus 数据库中搜索截至 2010 年 6 月的文章，旨在验证老年重症监护病房（ICU）患者生存或死亡率的预后模型。我们根据文献中报告的使用障碍，使用以下类别评估模型在其预期目的方面的适应性：（1）临床可信度，（2）方法学质量（基于现有质量评估框架），（3）外部有效性，（4）模型性能和（5）临床效果。
确定了符合纳入标准的七项研究，其中一项为外部验证研究。总共发现了 17 个模型，其中 6 个是为普通成年 ICU 患者开发的，11 个是专门为老年患者开发的。队列范围从 148 到 12993 例患者，只有较小的队列是前瞻性获得的。接收者操作特征曲线（ROC）下的面积最常用于衡量性能（范围为 0.71-0.88）。临床可信度的中位数为 7 项标准中的 4.5 项（范围为 2.5-5.5），方法学质量的中位数为 20 项标准中的 17 项（范围为 15-20）。
尽管这些模型在方法学质量方面得分相对较高，但目前没有一个模型可以被认为足够可信或有效，适用于老年患者的临床实践。未来的研究应集中在外部验证上，解决与其预期用途相关的性能指标，并关注临床可信度，包括纳入特定于老年人群的因素。
