ArticleCritical care explorations2024
Evaluating Prognostic Bias of Critical Illness Severity Scores Based on Age, Sex, and Primary Language in the United States: A Retrospective Multicenter Study.
Article in Critical care explorations, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed.
- Development and validation of a risk prediction model for hospital mortality in adult patients withFrontiers in cellular and infection microbiology · 2026Article
- APACHE II and NUTRIC Scores for Mortality Prediction in Chronic Critical Illness: A "Right-Side" Prognostic Modeling Approach.Diagnostics (Basel, Switzerland) · 2025Article
- GRACE-ICU: A multimodal nomogram-based approach for illness severity assessment of older adults in the ICU.NPJ digital medicine · 2025Article
- Prognosticating the outcome of intensive care in older patients-a narrative review.Annals of intensive care · 2024Review
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Authors and funding
9 authors.
Funding
Abstract
objectivesAlthough illness severity scoring systems are widely used to support clinical decision-making and assess ICU performance, their potential bias across different age, sex, and primary language groups has not been well-studied. DESIGN SETTING AND PATIENTS: We aimed to identify potential bias of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) IVa scores via large ICU databases. SETTING/PATIENTS: This multicenter, retrospective study was conducted using data from the Medical Information Mart for Intensive Care (MIMIC) and eICU Collaborative Research Database. SOFA and APACHE IVa scores were obtained from ICU admission. Hospital mortality was the primary outcome. Discrimination (area under receiver operating characteristic [AUROC] curve) and calibration (standardized mortality ratio [SMR]) were assessed for all subgroups.
interventionsNot applicable. MEASUREMENTS AND MAIN
resultsA total of 196,310 patient encounters were studied. Discrimination for both scores was worse in older patients compared with younger patients and female patients rather than male patients. In MIMIC, discrimination of SOFA in non-English primary language speakers patients was worse than that of English speakers (AUROC 0.726 vs. 0.783,
conclusionsDifferences in discrimination and calibration of two scores across varying age, sex, and primary language groups suggest illness severity scores are prone to bias in mortality predictions. Caution must be taken when using them for quality benchmarking and decision-making among diverse real-world populations.
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