Endgames Statistical Question

Prognostic scores

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g282 (Published 17 January 2014) Cite this as: BMJ 2014;348:g282

This article has a correction. Please see:

  1. Philip Sedgwick, reader in medical statistics and medical education1
  1. 1Centre for Medical and Healthcare Education, St George’s, University of London, London, UK
  1. p.sedgwick{at}sgul.ac.uk

Researchers investigated clinical indicators of immediate, early, and late mortality in children at admission to hospital. A prospective cohort study design was used. Participants were 8091 children aged more than 90 days admitted to a sub­Saharan district hospital in Kenya between 1 July 1998 and 30 June 2000. Children were excluded if admitted for trauma or elective procedures. Of the 8091 children admitted 436 (5%) died—60 (14%) died immediately, 193 (44%) died early, and 183 (42%) died late.1

Separate prognostic models were developed for immediate death (within 4 h of admission), early death (within 4-48 h), and late death (after 48 h). The models were developed from clinical indicators collected prospectively for children in the cohort on admission and at death or discharge.

The prognostic models were validated using data collected from a further cohort of 4802 children aged more than 90 days, admitted to the same hospital between 1 July 2000 and 30 June 2001. Children admitted for trauma and elective admissions were excluded. Of the 4802 children admitted in the validation cohort 222 (5%) died—26 (12%) immediately, 88 (40%) early, and 108 (49%) late. For each child a prognostic score for predicting immediate, early, and late death was derived by summing the total number of clinical indicators present. The performance of the prognostic scores was assessed by receiver operating characteristic curves (figure). The areas under the receiver operating characteristic curves were 0.93 (95% confidence interval 0.92 to 0.94) for immediate, 0.82 (0.80 to 0.83) for early, and 0.82 (0.81 to 0.84) for late deaths.

Receiver operating characteristic curves for the prognostic scores for immediate, early, and late death (n=4802). Prognostic scores were categorised as high risk (“positive”) of death if a certain number, or more, clinical indicators were present, otherwise they were categorised as low risk …

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