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11.3 - Principles of Outcome Prediction, Prognostic Indicators and Treatment Intensity Scales and Limitations of Scoring Systems in Predicting Individual Patient Outcome

from Section 11 - Professionalism, Patient Safety, Governance and Health Systems Management

Published online by Cambridge University Press:  27 July 2023

Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Precise estimates of post-operative mortality and morbidity are difficult to obtain and both are recognised to vary greatly, depending on a patient’s pre-operative functional status, the type and urgency of surgery and whether or not post-operative complications occur.

  2. 2. Risk scores apply a weighting to each factor, usually representing a component value for the score, with the resultant score corresponding with predicted risk.

  3. 3. Prognostic indicators may include population-based risk scores, individualised risk prediction models, objective functional capacity assessment and biomarkers.

  4. 4. Model discrimination describes how well a model discriminates between high- and low-risk patients, and is measured using a receiver operator characteristic curve (ROC) to calculate the area under the curve (AUC).

  5. 5. Technically, risk assessment tools are only valid for the specific patient population for whom the tool has been developed and on whom it has been tested.

Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
, pp. 746 - 748
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Bilimoria, KY, Liu, Y, Paruch, JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217:833–42.e1–3.CrossRefGoogle ScholarPubMed
Ferreira, FL, Bota, DP, Bross, A, Mélot, C, Vincent, JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–8.CrossRefGoogle ScholarPubMed
Moran, J, Wilson, F, Guinan, E, McCormick, P, Hussey, J, Moriarty, J. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth 2016;116:177–91.CrossRefGoogle ScholarPubMed
Protopapa, KL, Simpson, JC, Smith, NCE, Moonesinghe, SR. Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg 2014;101:1774–83.CrossRefGoogle ScholarPubMed
Prytherch, DR, Whiteley, MS, Higgins, B, Weaver, PC, Prout, WG, Powell, SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg 1998;85:1217–20.Google ScholarPubMed
Vincent, JL, Moreno, R, Takala, J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–10.CrossRefGoogle Scholar

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