Moser André, Raj Rahul, Reinikainen Matti, Jakob Stephan M, Takala Jukka
CTU Bern, Department of Clinical Research, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Crit Care. 2024 Aug;82:154814. doi: 10.1016/j.jcrc.2024.154814. Epub 2024 Apr 20.
Intensive care requires extensive resources. The ICUs' resource use can be compared using standardized resource use ratios (SRURs). We assessed the effect of mortality prediction models on the SRURs.
We compared SRURs using different mortality prediction models: the recent Finnish Intensive Care Consortium (FICC) model and the SAPS-II model (n = 68,914 admissions). We allocated the resources to severity of illness strata using deciles of predicted mortality. In each risk and year stratum, we calculated the expected resource use per survivor from our modelling approaches using length of ICU stay and Therapeutic Intervention Scoring System (TISS) points.
Resource use per survivor increased from one length of stay (LOS) day and around 50 TISS points in the first decile to 10 LOS-days and 450 TISS in the tenth decile for both risk scoring systems. The FICC model predicted mortality risk accurately whereas the SAPS-II grossly overestimated the risk of death. Despite this, SRURs were practically identical and consistent.
SRURs provide a robust tool for benchmarking resource use within and between ICUs. SRURs can be used for benchmarking even if recently calibrated risk scores for the specific population are not available.
重症监护需要大量资源。可以使用标准化资源使用比率（SRURs）来比较重症监护病房（ICU）的资源使用情况。我们评估了死亡率预测模型对SRURs的影响。
我们使用不同的死亡率预测模型比较了SRURs：最新的芬兰重症监护联盟（FICC）模型和简化急性生理学评分系统（SAPS-II）模型（68914例入院患者）。我们根据预测死亡率的十分位数将资源分配到疾病严重程度分层中。在每个风险和年份分层中，我们使用ICU住院时间和治疗干预评分系统（TISS）分数，通过我们的建模方法计算每位幸存者的预期资源使用情况。
对于这两种风险评分系统，每位幸存者的资源使用从第一个十分位数中的1个住院日（LOS）和大约50个TISS分数增加到第十个十分位数中的10个LOS日和450个TISS分数。FICC模型准确地预测了死亡风险，而SAPS-II则严重高估了死亡风险。尽管如此，SRURs实际上是相同且一致的。
SRURs为ICU内部和之间的资源使用基准比较提供了一个强大的工具。即使没有针对特定人群的最新校准风险评分，SRURs也可用于基准比较。
