Outcome prediction model for very elderly critically ill patients

Context. Very elderly critically ill patients have three possible hospital outcomes: discharge to home, discharge to a skilled nursing or rehabilitati on facility, or death. The factors associated with these outcomes are unkno wn. Objective. To develop a three-outcome prediction model for very elderly cri tically ill patients. Design. Retrospective chart abstraction with ordered logistic regression an alysis. Setting: Academic medical center. Patients. Four hundred and fifty-five patients 85 yrs or older admitted to intensive care units (ICU) during 1996 and 1997. Measurements and Main Results. A fitted ordinal logistic regression predict ive model was developed using data from 243 patients hospitalized in 1996, and validated on data from 212 patients hospitalized in 1997. Model variabl es include age, gender, baseline support level, type of ICU, heart rate at ICU admission, use of mechanical ventilation, vasopressors or a pulmonary a rtery catheter during the ICU stay, and the development of respiratory, neu rologic or hematologic failure or sepsis while in the ICU. When tested on t he 1997 data, the model was well calibrated and had a high discriminant ind ex. Conclusions. This mathematical model can be used to predict the risks of th ese three hospital outcomes for this population of patients. These predicti ons can provide a context when discussing goals and expectations with patie nts, families, and other healthcare providers and to aid in hospital discha rge planning.