Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA.
Department of Pharmacy, Augusta University Medical Center, Augusta, GA.
Am J Health Syst Pharm. 2020 Mar 5;77(6):474-478. doi: 10.1093/ajhp/zxz330.
The MRC-ICU, a novel regimen complexity scoring tool, provides an objective measure of medication regimen complexity in critically ill patients. The MRC-ICU may have the ability to evaluate the impact of critical care pharmacists on patient outcomes but requires further validation. The objective of this study was to confirm the external validity of the MRC-ICU scoring tool at multiple institutions and intensive care unit (ICU) settings.
This was a multicenter, prospective, observational study. The electronic medical record was reviewed to collect patient demographics and patient outcomes, and the medication administration record was reviewed to collect MRC-ICU scores at 24 hours, 48 hours, and ICU discharge. Validation was performed by assessing convergent and divergent validity of the score. Spearman rank-order correlation was used to determine correlation.
A total of 230 patients were evaluated across both centers in both medical ICUs and surgical ICUs. Differences between the original center and the new site included that total number of orders (29 vs 126; P < 0.001) and total number of medication orders (17 vs 36; P < 0.001) were higher at the new site, whereas the original site had higher overall MRC-ICU scores (14 vs 11; P = 0.004). The MRC-ICU showed appropriate convergent validity with number of orders and medication orders (all P < 0.001) and appropriate divergent validity with no significant correlation found between age, weight, or gender (all P > 0.05).
External validity of the MRC-ICU has been confirmed through evaluation at an external site and in the surgical ICU population. The MRC-ICU scoring tool requires prospective evaluation to provide objective data regarding optimal pharmacist use.
MRC-ICU 是一种新的治疗方案复杂性评分工具，可客观衡量重症患者的药物治疗方案复杂性。MRC-ICU 可能有能力评估重症监护药师对患者结局的影响，但需要进一步验证。本研究的目的是在多个机构和重症监护病房 (ICU) 环境下确认 MRC-ICU 评分工具的外部有效性。
这是一项多中心、前瞻性、观察性研究。回顾电子病历以收集患者人口统计学和患者结局数据，并回顾用药记录以在 24 小时、48 小时和 ICU 出院时收集 MRC-ICU 评分。通过评估评分的收敛和发散有效性来进行验证。使用 Spearman 等级相关系数来确定相关性。
在两个中心的两个医学 ICU 和外科 ICU 共评估了 230 名患者。原始中心和新站点之间的差异包括新站点的总医嘱数（29 与 126；P<0.001）和总用药医嘱数（17 与 36；P<0.001）更高，而原始站点的整体 MRC-ICU 评分更高（14 与 11；P=0.004）。MRC-ICU 与医嘱数量和用药医嘱数量具有适当的收敛有效性（均 P<0.001），与年龄、体重或性别之间无显著相关性（均 P>0.05），具有适当的发散有效性。
通过在外部站点和外科 ICU 人群中的评估，已经确认了 MRC-ICU 的外部有效性。MRC-ICU 评分工具需要前瞻性评估，以提供有关最佳药师使用的客观数据。
