TY - JOUR
T1 - Accuracy between ICU admission and discharge diagnoses in non-survivors
T2 - A retrospective cohort study
AU - Hulsewe, Hannah H.M.
AU - Wilbers, Thom
AU - van Rosmalen, Frank
AU - van Bommel, Jasper
AU - Brinkman, Sylvia
AU - van Bussel, Bas C.T.
AU - van der Horst, Iwan C.C.
AU - Schnabel, Ronny M.
N1 - Publisher Copyright: © 2025 The Authors
PY - 2025/8
Y1 - 2025/8
N2 - Introduction: Models predicting in-hospital mortality for intensive care unit (ICU) patients, like Acute Physiologic and Chronic Health Evaluation (APACHE) IV, depend on correct data about admission diagnoses. Incorrectly recording diagnoses or changes in diagnoses during admission may impact estimating mortality.Methods: All deceased patients admitted to the ICU between Jan 1, 2018 and Dec 31, 2020 were included. Up to two discharge diagnoses were assigned using APACHE IV diagnostic codes. These were compared to the up to two diagnoses documented at admission. When differences occurred, these were classified as registration errors or diagnostic change. The APACHE IV predicted mortality was calculated using either admission or discharge diagnoses. The agreement between both methods was expressed as the mean difference and the intra-class correlation coefficient (ICC). Results: 886 (16 %) of 5633 patients died. In 363 (41 %) patients, there was no difference between admission and discharge diagnoses. Registration errors occurred in 138 (16 %) patients. 416 (47 %) patients had diagnostic change. The mean difference between predictions was 0.019 (95 % CI: 0.015–0.024). The ICC was 0.97 (95 % CI: 0.97–0.98). Discussion: Differences between ICU admission and discharge diagnoses occur frequently, this leads to only a small discrepancy in the overall predicted mortality of deceased ICU patients.
AB - Introduction: Models predicting in-hospital mortality for intensive care unit (ICU) patients, like Acute Physiologic and Chronic Health Evaluation (APACHE) IV, depend on correct data about admission diagnoses. Incorrectly recording diagnoses or changes in diagnoses during admission may impact estimating mortality.Methods: All deceased patients admitted to the ICU between Jan 1, 2018 and Dec 31, 2020 were included. Up to two discharge diagnoses were assigned using APACHE IV diagnostic codes. These were compared to the up to two diagnoses documented at admission. When differences occurred, these were classified as registration errors or diagnostic change. The APACHE IV predicted mortality was calculated using either admission or discharge diagnoses. The agreement between both methods was expressed as the mean difference and the intra-class correlation coefficient (ICC). Results: 886 (16 %) of 5633 patients died. In 363 (41 %) patients, there was no difference between admission and discharge diagnoses. Registration errors occurred in 138 (16 %) patients. 416 (47 %) patients had diagnostic change. The mean difference between predictions was 0.019 (95 % CI: 0.015–0.024). The ICC was 0.97 (95 % CI: 0.97–0.98). Discussion: Differences between ICU admission and discharge diagnoses occur frequently, this leads to only a small discrepancy in the overall predicted mortality of deceased ICU patients.
UR - http://www.scopus.com/inward/record.url?scp=105000491333&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2025.155065
DO - 10.1016/j.jcrc.2025.155065
M3 - Article
C2 - 40121949
AN - SCOPUS:105000491333
SN - 0883-9441
VL - 88
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 155065
ER -