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Health status prediction in critically ill children: a pilot study introducing Standardized Health Ratios
N F de Keizer1, G J Bonsel, R J Gemke
1Department of Medical Informatics, Academic Medical Centre, Amsterdam, The Netherlands.
Insights
Predicting patient health status after intensive care is crucial. New models accurately forecast functional outcomes 1 year post-intensive care unit (ICU) admission, aiding performance evaluation.
Area of Science:
- Pediatric Intensive Care Medicine
- Health Outcomes Research
- Medical Informatics
Background:
- Standardized mortality rates are common for intensive care unit (ICU) performance but don't capture functional outcomes.
- Increasing survival rates in critically ill patients necessitate evaluation of long-term functional status and quality of life.
- Assessing post-ICU health status is vital for comprehensive performance metrics.
Purpose of the Study:
- To develop and validate predictive models for health status 1 year after pediatric intensive care.
- To explore the utility of the health-utility-index (HUI) in predicting long-term outcomes.
- To introduce the Standardized Health Ratio (SHR) as a novel performance indicator.
Main Methods:
- Prospective study of 209 surviving patients in a tertiary pediatric ICU.
- Collected admission and 1-year follow-up health status data.
- Developed two multiple regression models using admission variables and HUI to predict 1-year health status.
Main Results:
- Admission factors like sensation, mobility, and cognition were key predictors of 1-year health status.
- Predictive models demonstrated high accuracy (R² = 0.83 and 0.84).
- Health status 1 year post-ICU admission was significantly predictable.
Conclusions:
- Health status can be reliably predicted using admission data and validated tools like HUI.
- The proposed Standardized Health Ratio (SHR), combined with Standardized Mortality Ratios (SMR), offers a comprehensive ICU performance measure.
- This approach enhances the evaluation of intensive care beyond mortality rates.
Abstract:
Performance of intensive care is usually quantified by means of standardized mortality rates, where standardization is directed towards the severity of illness on admission. However, as more critically ill patients survive, functional outcome and quality of life of these patients becomes more important. In a prospective study in a 10-bed tertiary paediatric intensive care unit (ICU), admission and follow-up health status were collected for 209 surviving patients. For this cohort of patients, health status 1 year after admission was also predicted, using the quantified health-utility-index (HUI), as a value between 0 and 1. For this purpose, two alternative multiple regression models were constructed. The most important predictors of 1-year health status were the level of sensation, mobility and cognition on admission to which self-care, systolic blood pressure, oxygen, Glascow Coma Scale, glucose and age may be added. The two alternative predictive models performed equally well (R2 = 0.83 and 0.84 respectively), indicating that health status could be predicted to a significant degree. The concept of relating expected future health status (based on base-line health status), with actual (observed) health status is denoted with the Standardized Health Ratio (SHR). In combination with the Standardized Mortality Ratios (SMR), such a ratio may become a new comprehensive indicator of performance in intensive care medicine.