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Pilcher, David — Prediction in Critical Care: Science, Art or Foolishness?
The document discusses prediction in critical care medicine. It describes how prediction models can help evaluate patient outcomes and monitor performance over time through metrics like discrimination, calibration, and validation. Graphs show mortality predictions from models like APACHE III and ANZROD aligning closely with actual observed mortality rates. Hospitals can use standardized mortality ratios to compare their performance to predicted outcomes and identify areas for improvement. While predictions are common, developing accurate models requires ongoing effort to evaluate and improve them.
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Pilcher, David — Prediction in Critical Care: Science, Art or Foolishness?
- 1. Prediction in CriticalCare Science, Art or Foolishness David Pilcher @Intensive Dave The Alfred Hospital & ANZICS CORE
- 2. Michael 65yrs 83kg174cm Sepsis
- 3. 634 BC 23rdOctober 1998 1st January 2000 Predictions are common. 21st December 2012 26th April 2026
- 4.
- 5. “I do abit of modelling….” Predictions are common.
- 6. “I do abit of modelling….” Predictions are common.
- 7.
- 8. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity Binary Outcomes Only
- 9. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity Binary Outcomes Only
- 10. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity Binary Outcomes Only
- 11. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity Binary Outcomes Only Burns
- 12. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity Burns Area under Receiver Operator Characteristic = 0.92
- 13. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% 50yrs + = 40% 50%Mortality Sensitivity 1- specificity Burns Area under Receiver Operator Characteristic = 0.92
- 14. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% Area under Receiver Operator Characteristic = 0.92 Burns 0% 20% 40% 60% 80% 100% 50yrs + = 60% 50%Mortality Sensitivity 1- specificity
- 15. Discrimination Calibration Validation 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity 20% 15% 10% 5% 0% Mortality Year Predicted Mortality from APACHE III Observed Mortality Acute Physiology and Chronic Health APACHE Area under Receiver Operator Characteristic = 0.88
- 16. Discrimination Calibration Validation 14% 12% 10% 8% 6% 4% 2% 0% Year 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity APACHE III Observed Mortality ANZ Risk of Death Area under Receiver Operator Characteristic = 0.90
- 17. Discrimination Calibration Validation 14% 12% 10% 8% 6% 4% 2% 0% Year 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Sensitivity 1- specificity Observed Mortality ANZ Risk of Death Area under Receiver Operator Characteristic = 0.90 ANZROD
- 18. Michael 65yrs 83kg174cm Sepsis Is your ICU any good?
- 19. Observed Deaths PredictedDeaths = Standardised Mortality Ratio Is your ICU any good? Michael 65yrs 83kg 174cm Sepsis
- 20. Is your ICUany good? 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 0 200 400 600 800 1000 1200 1400 Number of admissions More deaths than predicted Less deaths than predicted Standardised Mortality Ratio Michael 65yrs 83kg 174cm Sepsis
- 21. Is your ICUany good? 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 0 200 400 600 800 1000 1200 1400 Number of admissions More deaths than predicted Less deaths than predicted Standardised Mortality Ratio Michael 65yrs 83kg 174cm Sepsis
- 22. 634 BC 23rdOctober 1998 1st January 2000 Predictions are common. 21st December 2012 26th April 2026
- 23. 634 BC 23rdOctober 1998 1st January 2000 21st December 2012 26th April 2026
- 24. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs
- 25. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs 26th April 2026
- 26. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs
- 27. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs
- 28. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs
- 29. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs
- 30. 40% 35% 30% 25% 20% 15% 10% 5% 0% Mortality Year Declining Mortality for Sepsis & Septic Shock in ANZ ICUs
- 31. Discrimination Calibration Validation Predictions are important. They tell us where are now and where we could be in the future. Thank you @IntensiveDave