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Validación de un Modelo de Predicción Clínica de Ingreso Precoz en la Unidad de Cuidados Intensivos de los Pacientes con Neumonía
Author(s) -
Labarère José,
Schuetz Philipp,
Renaud Bertrand,
Claessens YannErick,
Albrich Werner,
Mueller Beat
Publication year - 2012
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2012.01424.x
Subject(s) - medicine , pneumonia severity index , intensive care unit , pneumonia , receiver operating characteristic , confidence interval , emergency medicine , intensive care , emergency department , severity of illness , community acquired pneumonia , intensive care medicine , psychiatry
ACADEMIC EMERGENCY MEDICINE 2012; 19:993–1003 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: The Risk of Early Admission to the Intensive Care Unit (REA‐ICU) index is a clinical prediction model that was derived based on 4,593 patients with community‐acquired pneumonia (CAP) for predicting early admission to the intensive care unit (ICU; i.e., within 3 days following emergency department [ED] presentation). This study aimed to validate the REA‐ICU index in an independent sample. Methods: The authors retrospectively stratified 850 CAP patients enrolled in a multicenter prospective randomized trial conducted in Switzerland, using the REA‐ICU index, alternate clinical prediction models of severe pneumonia (SMART‐COP, CURXO‐80, and the 2007 IDSA/ATS minor severity criteria), and pneumonia severity assessment tools (the Pneumonia Severity Index [PSI] and CURB‐65). Results: The rate of early ICU admission did not differ between the validation and derivation samples within each risk class of the REA‐ICU index, ranging from 1.1% to 1.8% in risk class I to 27.1% to 27.6% in risk class IV. The areas under the receiver operating characteristic (ROC) curve were 0.76 (95% confidence interval [CI] = 0.70 to 0.83) and 0.80 (95% CI = 0.77 to 0.83) in the validation and derivation samples, respectively. In the validation sample, the REA‐ICU index performed better than the pneumonia severity assessment tools, but failed to demonstrate an accuracy advantage over alternate prediction models in predicting ICU admission. Conclusions: The REA‐ICU index reliably stratifies CAP patients into four categories of increased risk for early ICU admission within 3 days following ED presentation. Further research is warranted to determine whether inflammatory biomarkers may improve the performance of this clinical prediction model.