Predictive mortality models are not like fine wine 英文参考文献.docVIP

Critical Care December 2005 Vol 9 No 6 Kramer Commentary Predictive mortality models are not like fine wine Andrew A Kramer Senior Biostatistician, Cerner Corporation, 1953 Gallows Road, Suite 570, Vienna, VA 22182, USA Corresponding author: Andrew Kramer, akramer@ Published online: 26 October 2005 Critical Care 2005, 9:636-637 (DOI 10.1186/cc3899) This article is online at /content/9/6/636 ? 2005 BioMed Central Ltd See related research by Le Gall et al. in this issue [/content/9/6/R645] Abstract tends to get over predicted when older models are applied to more contemporary data, which in turn leads to ‘grade inflation’ when benchmarking intensive care unit (ICU) performance [7]. It is thus not surprising that Le Gall et al. [1] found similar results when applying the original SAPS II model (based on data from 1991 to 1992) to a ‘newer’ data set (1998 to 1999). A mortality model developed for US Veterans Administration patients [8] and a new generation of mortality models (APACHE IV, MPM0-III, and SAPS III) have been developed to address this well-documented phenome- non of ‘model fade’. The authors of a recent paper have described an updated simplified acute physiology score (SAPS) II mortality model developed on patient data from 1998 to 1999. Hospital mortality models have a limited range of applicability. SAPS II, Acute Physiology, Age, and Chronic Health Evaluation (APACHE) III, and mortality probability model (MPM)-II, which were developed in the early 1990s, have shown a decline in predictive accuracy as the models age. The deterioration in accuracy is manifested by a decline in the models’ calibration. In particular, mortality tends to get over predicted when older models are applied to more contemporary data, which in turn leads to ‘grade inflation’ when benchmarking intensive care unit (ICU) pe