Multicenter derivation and validation of an early warning score for acute respiratory failure or death in the hospital

Dziadzko, Mikhail A; Novotny, Paul J; Sloan, Jeff; Gajic, Ognjen; Herasevich, Vitaly; Mirhaji, Parsa; Wu, Yiyuan; Gong, Michelle Ng

doi:10.1186/s13054-018-2194-7

Critical Care

Table 2 Performance of APPROVE in retrospective and prospective validation cohorts to predict for qualifying event at any time after score calculation

From: Multicenter derivation and validation of an early warning score for acute respiratory failure or death in the hospital

		APPROVE			MEWS			NEWS
		Cutoff > 0.15	Cutoff > 0.20	Cutoff > 0.25	Cutoff > 4	Cutoff > 5	Cutoff > 6	Cutoff > 4	Cutoff > 5	Cutoff > 6
2013^a	Sensitivity (95% CI)	0.75 (0.72–0.77)	0.69 (0.66–0.71)	0.63 (0.60–0.66)	0.16 (0.13–0.18)	0.08 (0.07–0.11)	0.04 (0.03–0.06)	0.28 (0.25–0.31)	0.22 (0.19–0.25)	0.16 (0.13–0.18)
	Specificity (95% CI)	0.83 (0.83–0.83)	0.88 (0.88–0.89)	0.92 (0.92–0.92)	0.98 (0.98–0.98)	0.99 (0.99–0.99)	0.99 (0.99–0.99)	0.94 (0.94–0.94)	0.97 (0.97–0.97)	0.99 (0.98–0.99)
	Positive predictive value (95% CI)	0.13 (0.12–0.14)	0.17 (0.16–0.18)	0.21 (0.19–0.22)	0.19 (0.16–0.22)	0.37 (0.30–0.44)	0.54 (0.42–0.66)	0.11 (0.10–0.13)	0.16 (0.14–0.18)	0.22 (0.19–0.25)
	Negative predictive value (95% CI)	0.99 (0.99–0.99)	0.99 (0.99–0.99)	0.99 (0.99–0.99)	0.98 (0.98–0.98)	0.98 (0.97–0.98)	0.98 (0.97–0.98)	0.98 (0.98–0.98)	0.98 (0.98–0.98)	0.98 (0.98–0.98)
	False positive rate (95% CI)	0.17 (0.17–0.17)	0.12 (0.11–0.12)	0.08 (0.08–0.08)	0.02 (0.02–0.02)	0.01 (0.01–0.01)	0.01 (0.01–0.01)	0.06 (0.06–0.06)	0.03 (0.03–0.03)	0.01 (0.01-0.01)
2017^b	Sensitivity (95% CI)	0.89 (0.74–0.97)	0.69 (0.52–0.84)	0.64 (0.46–0.79)	0.67 (0.49–0.81)	0.39 (0.23–0.57)	0.19 (0.08–0.36)	0.67 (0.49–0.81)	0.47 (0.30–0.65)	0.39 (0.23–0.57)
	Specificity (95% CI)	0.85 (0.83–0.86)	0.91 (0.90–0.92)	0.95 (0.94–0.96)	0.86 (0.85–0.88)	0.96 (0.95–0.97)	0.99 (0.99–0.99)	0.75 (0.73–0.76)	0.86 (0.85–0.88)	0.93 (0.92–0.94)
	Positive predictive value (95% CI)	0.09 (0.06–0.12)	0.11 (0.07–0.16)	0.16 (0.11–0.23)	0.07 (0.05–0.11)	0.15 (0.08–0.23)	0.29 (0.13–0.51)	0.04 (0.03–0.06)	0.05 (0.03–0.08)	0.08 (0.05–0.14)
	Negative predictive value (95% CI)	0.99 (0.99–0.99)	0.99 (0.99–0.99)	0.99 (0.99–0.99)	0.99 (0.99–0.99)	0.99 (0.98–0.99)	0.99 (0.98–0.99)	0.99 (0.99–0.99)	0.99 (0.98–0.99)	0.99 (0.98–0.99)
	False positive rate (95% CI)	0.15 (0.13–0.16)	0.09 (0.08–0.10)	0.05 (0.04–0.06)	0.14 (0.12–0.15)	0.04 (0.03–0.04)	0.01 (0.00–0.01)	0.25 (0.23–0.27)	0.14 (0.12–0.15)	0.07 (0.06–0.08)

Qualifying event defined as death or intubation that leads to at least 48 h of mechanical ventilation
APPROVE Accurate Prediction of Prolonged Ventilation, CI confidence interval, MEWS Modified Early Warning Score, NEWS National Early Warning Score ale
^aAPPROVE calculated every time there are new data to predict for qualifying event any time in hospital after score calculation
^bAPPROVE calculated every 4 h after hospital admission to predict for qualifying event any time in hospital after score calculation

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ISSN: 1364-8535

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