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10.1016/S2589-7500(21)00022-4 http://scihub22266oqcxt.onion/10.1016/S2589-7500(21)00022-4 33766288!8063502!33766288     free     free     free Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 251.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 251.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 251.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Lancet+Digit+Health 2021 ; 3 (4): e241-e249 Nephropedia Template TP {{tp|p=33766288|t=2021. Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study |pdf=|usr=}}{{33766288}} gab.com Text Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study JO: Lancet Digit Health http://www.kidney.de/pget.php?&tw=1&pmid=33766288 #FOAvip 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 166 751 participants (122 919 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. FUNDING: There was no specific funding for this study. Twit Text FOAVip Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study ????Lancet Digit Health http://www.kidney.de/pget.php?&tw=1&pmid=33766288 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=33766288 #FOAvip English Wikipedia <ref>{{Cite pmid|33766288}}</ref> Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study #MMPMID33766288 Sarkar R; Martin C; Mattie H; Gichoya JW; Stone DJ; Celi LA Lancet Digit Health 2021[Apr]; 3 (4): e241-e249 PMID33766288show ga 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 166 751 participants (122 919 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. FUNDING: There was no specific funding for this study. |*Intensive Care Units[MESH] |*Racism[MESH] |*Severity of Illness Index[MESH] |Adolescent[MESH] |Adult[MESH] |Aged[MESH] |Aged, 80 and over[MESH] |Ethnicity[MESH] |Female[MESH] |Hospital Mortality/*ethnology[MESH] |Humans[MESH] |Male[MESH] |Middle Aged[MESH] |Organ Dysfunction Scores[MESH] |Racial Groups[MESH] |Retrospective Studies[MESH] |Risk Assessment/*ethnology[MESH] |United States/epidemiology[MESH]Performance of intensive care unit severity scoring systems across dif(epmc).pdf DeepDyve Pubget Overpricing