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Prognostic models for predicting mortality in elderly ICU patients: a systematic review

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Abstract

Purpose

To systematically review prognostic research literature on development and/or validation of mortality predictive models in elderly patients.

Methods

We searched the Scopus database until June 2010 for articles aimed at validating prognostic models for survival or mortality in elderly intensive care unit (ICU) patients. We assessed the models’ fitness for their intended purpose on the basis of barriers for use reported in the literature, using the following categories: (1) clinical credibility, (2) methodological quality (based on an existing quality assessment framework), (3) external validity, (4) model performance, and (5) clinical effectiveness.

Results

Seven studies were identified which met our inclusion criteria, one of which was an external validation study. In total, 17 models were found of which six were developed for the general adult ICU population and eleven specifically for elderly patients. Cohorts ranged from 148 to 12,993 patients and only smaller ones were obtained prospectively. The area under the receiver operating characteristic curve (AUC) was most commonly used to measure performance (range 0.71–0.88). The median number of criteria met for clinical credibility was 4.5 out of 7 (range 2.5–5.5) and 17 out of 20 for methodological quality (range 15–20).

Conclusions

Although the models scored relatively well on methodological quality, none of them can be currently considered sufficiently credible or valid to be applicable in clinical practice for elderly patients. Future research should focus on external validation, addressing performance measures relevant for their intended use, and on clinical credibility including the incorporation of factors specific for the elderly population.

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Conflict of interest

The author(s) declare that they have no competing interests, but they note that some co-authors of this review were co-authors of two of the reviewed studies. These co-authors, however, were not involved in selecting and scoring the quality of reviewed studies.

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Authors and Affiliations

  1. Department of Medical Informatics, Academic Medical Center, Room J1b-124, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Lilian Minne & Ameen Abu-Hanna

  2. Department of Quality, Process and Innovation, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Jeroen Ludikhuize

  3. Department of Geriatrics, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Sophia de Rooij

  4. Department of Intensive Care, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    Evert de Jonge

Authors
  1. Lilian Minne
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  2. Jeroen Ludikhuize
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  3. Evert de Jonge
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  4. Sophia de Rooij
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  5. Ameen Abu-Hanna
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Correspondence to Lilian Minne.

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Minne, L., Ludikhuize, J., de Jonge, E. et al. Prognostic models for predicting mortality in elderly ICU patients: a systematic review. Intensive Care Med 37, 1258–1268 (2011). https://doi.org/10.1007/s00134-011-2265-6

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  • DOI: https://doi.org/10.1007/s00134-011-2265-6

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