Yamana et al reported the Procedure-Based Severity Index to predicting mortality of inpatients based on procedures performed on the day of admission. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Tokyo.
Patient selection: hospital inpatient
Outcome: in-hospital mortality
Measure: procedures performed on the day of admission. For a group of procedures performed consecutively only the first procedure performed was scored.
Procedure
Points
invasive arterial pressure measurement
-3
blood tests excluding coagulation
-3
radiography
-2
urinalysis (excluding chemistry)
-2
temporary urinary catheter
-1
endocrinology tests
-1
bacterial microscopy or culture
-1
bacterial drug susceptibility test
1
urine chemistry tests
1
heart rate and/or respiration monitoring
2
peripheral intravenous infusion
2
CT scan
3
pulse oximetry
3
gastric drainage tube insertion
4
urinary catheter insertion
5
central venous catheter insertion
5
vasopressor therapy (catecholamines, vasopressin)
8
sputum suction
12
endotracheal intubation
23
total score =
= SUM(points for all 19 procedures)
Interpretation:
• minimum score: -13 (-12 was minimum score seen in cohort)
• maximum score: 69 (62 was maximum score seen in cohort)
• The higher the score the greater the mortality.
Score
Mortality
<= -6
4%
-5 to -3
5%
-2 to 3
5 to 10%
4 or 5
10%
6 to 14
10 to 20%
15 to 18
20 to 30%
19 to 21
30 to 35%
22 to 27
40%
> 27
> 50%
from Figure 1
Performance:
• The area under the ROC curve was 0.77.
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