van Gemert Julian, Zegers Marieke, Adang Eddy, Bakhshi-Raiez Ferishta, Simons Koen, Corsten Stijn, Westerhof Brigitte, Ewalds Esther, de Vries Marijke, Dongelmans Dave, de Keizer Nicolette, van den Boogaard Mark
Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, Gelderland, 6500 HB, The Netherlands.
Department of Health Evidence, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, Gelderland, 6500 HB, The Netherlands.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf078.
Measuring patient-reported outcome measures (PROMs) is essential for improving intensive care medicine, but it is challenging and prone to bias. This study investigates the representativeness of a multicenter, PROM-based cohort of intensive care unit (ICU) survivors.
Demographic, clinical, and ICU admission characteristics of the multicenter, PROM-based cohort (n = 6 ICUs) were compared to those of all ICU survivors in Dutch hospitals (n = 73 ICUs), in the years 2019 and 2022, based on data from the National Intensive Care Evaluation registry.
Comparison between the PROM-based cohort (n = 2454) and the national registry cohort (n = 89 154) revealed predominantly similarities in demographic, clinical, and ICU admission characteristics. Nevertheless, ICU survivors in the PROM-based cohort had a higher severity of illness (59 vs. 56 points) and mortality probability (19% vs. 16%), were more often mechanically ventilated during the first 24 h after ICU admission (49% vs. 34%), had higher ICU and hospital lengths of stay (respectively, 4.7 vs. 3.6 days, and 16 vs. 14 days), and lower mortality rates in-hospital and at 3, 6, and 12 months after ICU admission (respectively, 1.4% vs. 4.6%, 4.2% vs. 10%, 6.2% vs. 13%, and 9.2% vs. 17%).
ICU survivors in the PROM-based cohort share similar demographic, clinical, and ICU admission characteristics with the national ICU population. However, severity of illness, lengths of stay, and mortality rates deviate from the national registry cohort. These findings highlight external validity concerns, urging researchers and policymakers to consider this when using outcome data from a PROM-based cohort.
测量患者报告的结局指标（PROMs）对于改善重症监护医学至关重要，但具有挑战性且容易产生偏差。本研究调查了一个基于PROMs的多中心重症监护病房（ICU）幸存者队列的代表性。
根据国家重症监护评估登记处的数据，将2019年和2022年基于PROMs的多中心队列（n = 6个ICU）的人口统计学、临床和ICU入院特征与荷兰医院所有ICU幸存者（n = 73个ICU）的特征进行比较。
基于PROMs的队列（n = 2454）与国家登记队列（n = 89154）之间的比较显示，在人口统计学、临床和ICU入院特征方面主要相似。然而，基于PROMs的队列中的ICU幸存者疾病严重程度更高（59分对56分），死亡概率更高（19%对16%），在ICU入院后的前24小时内接受机械通气的频率更高（49%对34%），ICU和住院时间更长（分别为4.7天对3.6天和16天对14天），并且在ICU入院后住院期间以及3、6和12个月时的死亡率更低（分别为1.4%对4.6%、4.2%对10%、6.2%对13%和9.2%对17%）。
基于PROMs的队列中的ICU幸存者与全国ICU人群在人口统计学、临床和ICU入院特征方面相似。然而，疾病严重程度、住院时间和死亡率与国家登记队列有所不同。这些发现凸显了外部有效性问题，促使研究人员和政策制定者在使用基于PROMs的队列的结局数据时予以考虑。
