Development and Validation of a Prediction Model for 1-Year Mortality in Patients With a Hematologic Malignancy Admitted to the ICU.

OBJECTIVES: To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU. DESIGN: A retrospective cohort study. SETTING: Five university hospitals in the Netherlands between 2002 and 2015. PATIENTS: A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model's generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal-external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59-65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal-external validation across centers (C-statistic 0.70; 95% CI, 0.63-0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (C-statistic 0.61; 95% CI, 0.57-0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60-100% predicted 1-year mortality. CONCLUSIONS: Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients.

RATIONALE, AIMS, AND OBJECTIVES: Since adequate staffing in intensive care units (ICUs) is an increasing problem worldwide, we investigated whether physician assistants (PAs) are able to substitute medical residents (MR) in ICUs with at least the same quality of clinical skills. In this study, we analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, MR with 6 to 24 months of work experience in the ICU. METHOD: Physician assistants and MRs in the ICUs were observed on their clinical skills by means of a simulated ICU comprising 2 scenarios on a human patient simulator with typical ICU cases. The level of clinical skills of PAs and MRs was videotaped and scored with predefined checklists by 2 independent intensivists per scenario. Percentage of the total score was calculated, and means were compared by Student t test. RESULTS: A total of 11 PAs and 10 MRs participated in the study. Physician assistants and MRs scored equal (PA 66% ± 13% vs MR 68% ± 9%, P = .86) on their clinical performance in the simulated ICU setting. CONCLUSION: This study showed equal performance of PAs and MRs on clinical skills in the simulated ICU setting.