Evaluation of standard and modified severity of illness scores in the obstetric patient

Lapinsky, Stephen E.; Hallett, David; Collop, Nancy A.; Drover, John W.; Lavercombe, Peter S; Leeman, Marc; Moola, Shiraz; Paruk, Fathima; Bernstein, Michael A.; Moodley, J.

doi:10.1016/j.jcrc.2010.10.003

Cited by 42 publications

(37 citation statements)

References 25 publications

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“…The prognostic scales commonly used at ICUs assign higher risks of death to pregnant women than to the general population, especially to pregnant women with obstetric conditions [23]. This difference occurs because the characteristics scored by the scales are the very physiologic characteristics of pregnancy [24].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit

Ríos

Risso-Vázquez

Álvarez

et al. 2012

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit

Ríos

Risso-Vázquez

Álvarez

et al. 2012

Intl J Gynecology & Obste

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“…The formula—[N = (n × 10) / I]—was used to calculate the sample size where N = the required sample size, n = the number of variables to be tested, and I = the incidence of the combined adverse outcome [14]. We assumed, on the basis of published reports, I = 12% for either maternal mortality or prolonged organ support for obstetric women admitted for critical care [15]. We estimated that to develop a reliable model with minimal overfitting with n = 10 candidate predictor variables at an assumed event rate of 12%, a cohort of N = 833 women was required.…”

Section: Methodsmentioning

confidence: 99%

Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

et al. 2018

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BackgroundIntensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care.MethodsA retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than 24 h during pregnancy or less than 6 weeks post-partum from 2000 to 2012 were included in the cohort. A composite primary outcome was defined as maternal death or need for organ support for more than 7 days or acute life-saving intervention. Model development involved selection of candidate predictor variables based on prior evidence of effect, availability across study sites, and use of LASSO (Least Absolute Shrinkage and Selection Operator) model building after multiple imputation using chained equations to address missing data for variable selection. The final model was estimated using multivariable logistic regression. Internal validation was completed using bootstrapping to correct for optimism in model performance measures of discrimination and calibration.ResultsOverall, 127 out of 769 (16.5%) women experienced an adverse outcome. Predictors included in the final CIPHER model were maternal age, surgery in the preceding 24 h, systolic blood pressure, Glasgow Coma Scale score, serum sodium, serum potassium, activated partial thromboplastin time, arterial blood gas (ABG) pH, serum creatinine, and serum bilirubin. After internal validation, the model maintained excellent discrimination (area under the curve of the receiver operating characteristic (AUROC) 0.82, 95% confidence interval (CI) 0.81 to 0.84) and good calibration (slope of 0.92, 95% CI 0.91 to 0.92 and intercept of −0.11, 95% CI −0.13 to −0.08).ConclusionsThe CIPHER model has the potential to be a pragmatic risk prediction tool. CIPHER can identify critically ill pregnant women at highest risk for adverse outcomes, inform counseling of patients about risk, and facilitate bench-marking of outcomes between centers by adjusting for baseline risk.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2215-6) contains supplementary material, which is available to authorized users.

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“…As a result, traditional risk stratification models usually overestimate mortality among pregnant women, which may hinder analysis of the performance of care provided and interpretation of morbidity and mortality outcomes [3]. …”

Section: Introductionmentioning

confidence: 99%

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

Haddad

Cecatti

Souza

et al. 2014

BioMed Research International

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Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

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Evaluation of standard and modified severity of illness scores in the obstetric patient

Cited by 42 publications

References 25 publications

Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit

Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit

Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

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