Predictive Ability of an Illness Severity Measure: Implications for Nursing Research

Area of Science:

• Pediatric healthcare research
• Clinical informatics
• Biostatistics

Background:

• Illness severity in children with life-limiting conditions is assessed using the pediatric complex chronic conditions (CCC) measure.
• The CCC measure was initially developed in 2000/2001 and revised in 2014 with infant-specific additions.

Purpose of the Study:

• To evaluate the predictive performance of the original and revised pediatric complex chronic conditions (CCC) measures.
• To assess the accuracy and discrimination of these measures in predicting end-of-life outcomes in infants.

Main Methods:

• Utilized discrimination, calibration, and accuracy tests to examine predictive performance.
• Included 10,175 infants in the analysis.
• Employed C-statistics for discrimination and Brier Scores for accuracy.

Main Results:

• Both the original and revised CCC measures demonstrated poor discrimination for palliative care consultation and inpatient procedures.
• The original CCC measure was more accurate in predicting end-of-life outcomes, evidenced by lower Brier Scores.
• Good calibration was observed for both measures using Hosmer-Lemeshow tests.

Conclusions:

• The 2014 revision of the pediatric complex chronic conditions (CCC) measure did not enhance its predictive performance for end-of-life outcomes in infants.
• Further refinement of the CCC measure may be needed to improve its utility in this population.