PDF(Pubmed)
Abstract：
UNASSIGNED: Resuscitation can sometimes be futile and making a do-not-resuscitate (DNR) decision is in the best interest of the patient. The electronic poor outcome screening (ePOS) score was developed to predict 6-month poor outcomes of critically ill patients. We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit (ICU).
UNASSIGNED: This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023. Prospectively, we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders. The ability of the score to predict DNR was explored using logistic regression. Youden\'s ideal cut-off value was calculated using the DeLong method, and different diagnostic accuracy measures were generated with corresponding 95 % confidence intervals (CIs).
UNASSIGNED: We enrolled 857 patients, 125 received a DNR order and 732 did not. The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7, respectively. ePOS score, as a predictor of DNR order, had an area under receiver operator characteristic (AUROC) curve of 81.8 % (95% CI: 79.0 to 84.3, P <0.001). Youden\'s ideal cut-off value >17 was associated with a sensitivity of 87.2 (95% CI: 80.0 to 92.5, P <0.001), specificity of 63.9 (95% CI: 60.3 to 67.4, P <0.001), positive predictive value of 29.2 (95% CI: 24.6 to 33.8, P <0.001), negative predictive value of 96.7 (95% CI: 95.1 to 98.3, P <0.001), and diagnostic odds ratio 12.1 (95% CI: 7.0 to 20.8, P <0.001).
UNASSIGNED: In this study, the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay. A cut-off score >17 may help guide clinical decisions to withhold or commence resuscitative measures.
UNASSIGNED: This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023. Prospectively, we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders. The ability of the score to predict DNR was explored using logistic regression. Youden\'s ideal cut-off value was calculated using the DeLong method, and different diagnostic accuracy measures were generated with corresponding 95 % confidence intervals (CIs).
UNASSIGNED: We enrolled 857 patients, 125 received a DNR order and 732 did not. The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7, respectively. ePOS score, as a predictor of DNR order, had an area under receiver operator characteristic (AUROC) curve of 81.8 % (95% CI: 79.0 to 84.3, P <0.001). Youden\'s ideal cut-off value >17 was associated with a sensitivity of 87.2 (95% CI: 80.0 to 92.5, P <0.001), specificity of 63.9 (95% CI: 60.3 to 67.4, P <0.001), positive predictive value of 29.2 (95% CI: 24.6 to 33.8, P <0.001), negative predictive value of 96.7 (95% CI: 95.1 to 98.3, P <0.001), and diagnostic odds ratio 12.1 (95% CI: 7.0 to 20.8, P <0.001).
UNASSIGNED: In this study, the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay. A cut-off score >17 may help guide clinical decisions to withhold or commence resuscitative measures.
摘要：
■复苏有时可能是徒劳的，做出不复苏（DNR）决定符合患者的最大利益。电子不良结局筛查（ePOS）评分用于预测危重患者的6个月不良结局。我们探索了ePOS评分在预测重症监护病房（ICU）的DNR决策中的诊断准确性。
■这项研究于2023年3月至5月在沙特阿拉伯一家三级转诊医院的ICU进行。Prospective,我们计算了所有符合条件的连续入院患者在ICU48小时后的ePOS评分,并记录了DNR顺序.使用逻辑回归探索评分预测DNR的能力。尤登的理想临界值是用德隆方法计算的，并以相应的95%置信区间(CI)生成不同的诊断准确性度量。
■我们招募了857名患者，125收到DNR订单，732没有。DNR和非DNR患者的平均ePOS评分分别为28.2±10.7和15.2±9.7。ePOS评分,作为DNR顺序的预测因子，受试者操作特征(AUROC)曲线下面积为81.8%(95%CI:79.0~84.3,P<0.001)。Youden的理想临界值>17与87.2的灵敏度相关（95％CI：80.0至92.5，P<0.001），特异性为63.9（95%CI：60.3至67.4，P<0.001），阳性预测值为29.2（95％CI：24.6至33.8，P<0.001），阴性预测值为96.7（95％CI：95.1至98.3，P<0.001），诊断比值比12.1（95%CI：7.0至20.8，P<0.001）。
■在这项研究中，ePOS评分作为ICU入住期间被标记为DNR的患者的诊断测试效果良好.截止分数>17可以帮助指导临床决定停止或开始复苏措施。
■这项研究于2023年3月至5月在沙特阿拉伯一家三级转诊医院的ICU进行。Prospective,我们计算了所有符合条件的连续入院患者在ICU48小时后的ePOS评分,并记录了DNR顺序.使用逻辑回归探索评分预测DNR的能力。尤登的理想临界值是用德隆方法计算的，并以相应的95%置信区间(CI)生成不同的诊断准确性度量。
■我们招募了857名患者，125收到DNR订单，732没有。DNR和非DNR患者的平均ePOS评分分别为28.2±10.7和15.2±9.7。ePOS评分,作为DNR顺序的预测因子，受试者操作特征(AUROC)曲线下面积为81.8%(95%CI:79.0~84.3,P<0.001)。Youden的理想临界值>17与87.2的灵敏度相关（95％CI：80.0至92.5，P<0.001），特异性为63.9（95%CI：60.3至67.4，P<0.001），阳性预测值为29.2（95％CI：24.6至33.8，P<0.001），阴性预测值为96.7（95％CI：95.1至98.3，P<0.001），诊断比值比12.1（95%CI：7.0至20.8，P<0.001）。
■在这项研究中，ePOS评分作为ICU入住期间被标记为DNR的患者的诊断测试效果良好.截止分数>17可以帮助指导临床决定停止或开始复苏措施。
