Severe @entity497 : use of intensive care services and evaluation of American and British XXXX Society Diagnostic criteria.

@entity1 @entity55 @entity1457 @entity1514 @entity497 @entity1213 @entity1576 @entity204
Despite careful evaluation of changes in hospital care for @entity497 ( @entity497 ), little is known about @entity1213 ( @entity1213 ) use in the treatment of this disease. There are criteria that define @entity497 as "severe," but evaluation of their predictive value is limited. We compared characteristics, course, and outcome of inpatients who did (n = 170) and did not (n = 1,169) receive @entity1213 care in the @entity55 @entity1 Outcomes Research Team prospective cohort. We also assessed the predictive characteristics of four prediction rules (the original and revised American @entity1514 Society criteria, the British @entity1514 Society criteria, and the @entity55 Severity Index [PSI]) for @entity1213 admission, mechanical ventilation, medical complications, and @entity204 (as proxies for severe @entity497 ). @entity1213 @entity1 were more likely to be admitted from home and had more comorbid conditions. Reasons for @entity1213 admission included @entity1576 (57%), hemodynamic monitoring (32%), and @entity1457 (16%). @entity1213 @entity1 incurred longer hospital stays (23.2 vs. 9.1 days, p < 0.001), higher hospital costs (21,144 dollars vs. 5,785 dollars, p < 0.001), more nonpulmonary organ dysfunction, and higher hospital mortality (18.2 vs. 5.0%, p < 0.001). Although @entity1213 @entity1 were sicker, 27% were of low risk (PSI Risk Classes I-III). Severity-adjusted @entity1213 admission rates varied across institutions, but mechanical ventilation rates did not. The revised American @entity1514 Society criteria rule was the best discriminator of @entity1213 admission and mechanical ventilation (area under the receiver operating characteristic curve, 0.68 and 0.74, respectively) but none of the prediction rules were particularly good. The PSI was the best predictor of medical complications and @entity204 (area under the receiver operating characteristic curve, 0.65 and 0.75, respectively), but again, none of the prediction rules were particularly good. In conclusion, @entity1213 use for @entity497 is common and expensive but admission rates are variable. Clinical prediction rules for severe @entity497 do not appear adequately robust to guide clinical care at the current time.
