干旱区生态环境知识资源中心(Arid): Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study

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	Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study
	Sarkar, Rahuldeb; Martin, Christopher; Mattie, Heather; Gichoya, Judy Wawira; Stone, David J.; Celi, Leo Anthony
通讯作者	Celi, LA (corresponding author), MIT, Lab Computat Physiol, 77 Massachusetts Ave, Cambridge, MA 02139 USA.
来源期刊	LANCET DIGITAL HEALTH
EISSN	2589-7500
出版年	2021
卷号	3 期号:4 页码:E241-E249
英文摘要	Background Despite wide use of severity scoring systems for case-mix determination and benchmarking in the intensive care unit (ICU), the possibility of scoring bias across ethnicities has not been examined. Guidelines on the use of illness severity scores to inform triage decisions for allocation of scarce resources, such as mechanical ventilation, during the current COVID-19 pandemic warrant examination for possible bias in these models. We investigated the performance of the severity scoring systems Acute Physiology and Chronic Health Evaluation IVa (APACHE IVa), Oxford Acute Severity of Illness Score (OASIS), and Sequential Organ Failure Assessment (SOFA) across four ethnicities in two large ICU databases to identify possible ethnicity-based bias. Methods Data from the electronic ICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care III (MIMIC-III) database, built from patient episodes in the USA from 2014-15 and 2001-12, respectively, were analysed for score performance in Asian, Black, Hispanic, and White people after appropriate exclusions. Hospital mortality was the outcome of interest. Discrimination and calibration were determined for all three scoring systems in all four groups, using area under receiver operating characteristic (AUROC) curve for different ethnicities to assess discrimination, and standardised mortality ratio (SMR) or proxy measures to assess calibration. Findings We analysed 166751 participants (122919 eICU-CRD and 43 832 MIMIC-III). Although measurements of discrimination were significantly different among the groups (AUROC ranging from 0.86 to 0.89 [p=0.016] with APACHE IVa and from 0.75 to 0.77 [p=0.85] with OASIS), they did not display any discernible systematic patterns of bias. However, measurements of calibration indicated persistent, and in some cases statistically significant, patterns of difference between Hispanic people (SMR 0.73 with APACHE IVa and 0.64 with OASIS) and Black people (0.67 and 0.68) versus Asian people (0.77 and 0.95) and White people (0.76 and 0.81). Although calibrations were imperfect for all groups, the scores consistently showed a pattern of overpredicting mortality for Black people and Hispanic people. Similar results were seen using SOFA scores across the two databases. Interpretation The systematic differences in calibration across ethnicities suggest that illness severity scores reflect statistical bias in their predictions of mortality. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
类型	Article
语种	英语
开放获取类型	DOAJ Gold, Green Accepted, Green Published
收录类别	SCI-E
WOS记录号	WOS:000633036200009
WOS类目	Medical Informatics ; Medicine, General & Internal
WOS研究方向	Medical Informatics ; General & Internal Medicine
来源机构	University of London
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/351056
作者单位	[Sarkar, Rahuldeb] Medway NHS Fdn Trust, Dept Resp Med, Gillingham, Kent, England; [Sarkar, Rahuldeb] Medway NHS Fdn Trust, Dept Crit Care, Gillingham, Kent, England; [Sarkar, Rahuldeb] Kings Coll London, Fac Life Sci, London, England; [Martin, Christopher] UCL Inst Hlth Informat, London, England; [Mattie, Heather; Celi, Leo Anthony] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA; [Gichoya, Judy Wawira] Emory Univ, Dept Radiol & Imaging Sci, Intervent Radiol & Informat, Atlanta, GA USA; [Stone, David J.] Univ Virginia, Sch Med, Dept Anesthesiol, Charlottesville, VA USA; [Stone, David J.] Univ Virginia, Sch Med, Dept Neurosurg, Charlottesville, VA USA; [Stone, David J.] Univ Virginia, Sch Med, Ctr Adv Med Analyt, Charlottesville, VA USA; [Celi, Leo Anthony] MIT, Lab Computat Physiol, 77 Massachusetts Ave, Cambridge, MA 02139 USA; [Celi, Leo Anthony] Beth Israel Deaconess Med Ctr, Div Pulm Crit Care & Sleep Med, Boston, MA 02215 USA
推荐引用方式 GB/T 7714	Sarkar, Rahuldeb,Martin, Christopher,Mattie, Heather,et al. Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study[J]. University of London,2021,3(4):E241-E249.
APA	Sarkar, Rahuldeb,Martin, Christopher,Mattie, Heather,Gichoya, Judy Wawira,Stone, David J.,&Celi, Leo Anthony.(2021).Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study.LANCET DIGITAL HEALTH,3(4),E241-E249.
MLA	Sarkar, Rahuldeb,et al."Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study".LANCET DIGITAL HEALTH 3.4(2021):E241-E249.