Detecting Potentially Ineffective Care in Critically Ill Patients in a Community Hospital: Assessing Sustained Predictive Value after Two Decades

Background: Eighteen years ago, we derived a formula to predict 100-day post-discharge mortality, utilizing the Acute Physiology and Chronic Health Evaluation III (APACHE III) data. This study was designed to reassess this formula when applied to a new cohort of patients, utilizing the updated predictive hospital mortality equations derived from APACHE IV. Methods: Compared with the 1995‒1997 cohort in our original study, this study included a cohort of intensive care unit patients from 2012‒2017, with similar demographics. Both cohorts included patients >18 years old admitted to and surviving at least five days of intensive care in the Sarasota Memorial Hospital in Sarasota, Florida, USA. Results: In the recent cohort, the formula exhibited a specificity of 99.7%, sensitivity of 17.8%, false positive rate of 0.3%, and positive predictive value of 92.6%; applied to the original cohort, the formula exhibited values of 98.7%, 33.8%, 1.3%, and 93.3%, respectively. There was no statistical difference between the two databases, except in sensitivity. Conclusions: Potentially ineffective care can be predicted with nearly the same specificity and predictive value using the formula developed in the 2002 study. If these results are reproducible at other institutions, they could assist in patient/family and palliative care discussions.