title: Design and Performance of a New Severity Score for Intermediate Care.
abstract: BACKGROUND
  Application of illness-severity scores in Intermediate Care Units (ImCU) shows conflicting results. The aim of the study is to design a severity-of-illness score for patients admitted to an ImCU.
  
  
  METHODS
  We performed a retrospective observational study in a single academic medical centre in Pamplona, Spain. Demographics, past medical history, reasons for admission, physiological parameters at admission and during the first 24 hours of ImCU stay, laboratory variables and survival to hospital discharge were recorded. Logistic regression analysis was performed to identify variables for mortality prediction.
  
  
  RESULTS
  A total of 743 patients were included. The final multivariable model (derivation cohort = 554 patients) contained only 9 variables obtained at admission to the ImCU: previous length of stay 7 days (6 points), health-care related infection (11), metastatic cancer (9), immunosuppressive therapy (6), Glasgow comma scale 12 (10), need of non-invasive ventilation (14), platelets 50000/mcL (9), urea 0.6 g/L (10) and bilirubin 4 mg/dL (9). The ImCU severity score (ImCUSS) is generated by summing the individual point values, and the formula for determining the expected in-hospital mortality risk is: e(ImCUSS points*0.099 - 4,111)/(1 + e(ImCUSS points*0.099 - 4,11)1). The model showed adequate calibration and discrimination. Performance of ImCUSS (validation cohort = 189 patients) was comparable to that of SAPS II and 3. Hosmer-Lemeshow goodness-of-fit C test was χ2 8.078 (p=0.326) and the area under receiver operating curve 0.802.
  
  
  CONCLUSIONS
  ImCUSS, specially designed for intermediate care, is based on easy to obtain variables at admission to ImCU. Additionally, it shows a notable performance in terms of calibration and mortality discrimination.
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Alegre
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
authors.forename: Manuel Fortún
authors.initials: MF
authors.lastname: Landecho
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Huerta
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Fernández-Ros
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Martínez-Urbistondo
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: García
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
authors.affiliation: Division of Intermediate Care and Hospitalists Unit, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors.forename: Juan Felipe
authors.initials: JF
authors.lastname: Lucena
mesh_terms: D000368:Aged; D002138:Calibration; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index