Using severity measures to predict the likelihood of death for pneumonia inpatients.
OBJECTIVE
To see whether predictions of patients, likelihood of dying in-hospital differed among severity methods.


METHODS
Retrospective cohort.


METHODS
18,016 persons 18 years of age and older managed medically for pneumonia; 1,732 (9.6%) in-hospital deaths.


METHODS
Probability of death was calculated for each patient using logistic regression with age, age squared, sex, and each of five severity measures as the independent variables: 1) admission MedisGroups probability of death scores; 2) scores based on 17 admission physiologic variables; 3) Disease Staging's probability of mortality model; the Severity Score of Patient Management Categories (PMCs); 4) and the All Patient Refined Diagnosis-Related Groups (APR-DRGs). Patients were ranked by calculated probability of death; 5) rankings were compared across severity methods. Frequencies of 14 clinical findings considered poor prognostic indicators in pneumonia were examined for patients ranked differently by different methods.


RESULTS
MedisGroups and the physiology score predicted a similar likelihood of death for 89.2% of patients. In contrast, the three code-based severity methods rated over 25% of patients differently by predicted likelihood of death when compared with the rankings of the two clinical data-based methods [MedisGroups and the physiology score]. MedisGroups and the physiology score demonstrated better clinical credibility than the three severity methods based on discharge abstract data.


CONCLUSIONS
Some pairs of severity measures ranked over 25% of patients very differently by predicted probability of death. Results of outcomes studies may vary depending on which severity method is used for risk adjustment.
Iezzoni
L I
LI
Department of Medicine, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215, USA.
Shwartz
M
M
Ash
A S
AS
Mackiernan
Y D
YD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000401:mortality* / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014481:United States / Q000453:epidemiology