Accuracy of a Risk Alert Threshold for ICU Hypoglycemia: Retrospective Analysis of Alert Performance and Association with Clinical Deterioration Events
Abstract Objective To quantify the accuracy of and clinical events associated with a risk alert threshold for impending hypoglycemia during ICU admissions.Design Retrospective electronic health record review of clinical events occurring ≥1 and ≤12 hours after the hypoglycemia risk alert threshold was met.Setting Adult ICU admissions from June 2020 through April 2021 at the University of Virginia Medical Center.Patients 342 critically-ill adults that were 63.5% male with median age 60.8 years, median weight 79.1 kg, and median body mass index of 27.5 kg/m2.Interventions Real-world testing of our validated predictive model as a clinical decision support tool for ICU hypoglycemia.Measurements and Main Results We retrospectively reviewed 350 hypothetical alerts that met inclusion criteria for analysis. The alerts correctly predicted 48 cases of Level 1 hypoglycemia that occurred ≥1 and ≤12 hours after the alert threshold was met (positive predictive value= 13.7%). Twenty-one of these 48 cases (43.8%) involved Level 2 hypoglycemia. Notably, three myocardial infarctions, one medical emergency team call, two initiations of cardiopulmonary resuscitation, 6 unplanned surgeries, 19 deaths, 20 arrhythmias, and 38 blood or urine cultures were identified or obtained ≥1 and ≤12 hours after an alert threshold was met. Alerts identified 102 total events of hypoglycemia and/or clinical deterioration, yielding a positive predictive value for any event of 29.1%.Conclusions Alerts generated by a validated ICU hypoglycemia prediction model had positive predictive value of 29.1% for hypoglycemia and other associated adverse clinical events.Key Points Question What are the accuracy of and clinical events associated with a risk alert threshold for ICU hypoglycemia?Findings We retrospectively reviewed 350 hypothetical alerts that correctly predicted 48 cases of Level 1 hypoglycemia occurring ≥1 and ≤12 hours after the alert threshold was met (positive predictive value= 13.7%). Notably, three myocardial infarctions, one medical emergency team call, two initiations of cardiopulmonary resuscitation, 6 unplanned surgeries, 19 deaths, 20 arrhythmias, and 38 blood or urine cultures were identified or obtained ≥1 and ≤12 hours after an alert threshold was met.Meaning Alerts generated by a validated ICU hypoglycemia prediction model had positive predictive value of 29.1% for hypoglycemia and other associated adverse clinical events..
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Preprint| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
bioRxiv.org - (2024) vom: 23. Apr. Zur Gesamtaufnahme - year:2024 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Horton, William B. [VerfasserIn] |
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| doi: |
10.1101/2022.06.15.22276435 |
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| PPN (Katalog-ID): |
XBI036300802 |
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| 520 | |a Abstract Objective To quantify the accuracy of and clinical events associated with a risk alert threshold for impending hypoglycemia during ICU admissions.Design Retrospective electronic health record review of clinical events occurring ≥1 and ≤12 hours after the hypoglycemia risk alert threshold was met.Setting Adult ICU admissions from June 2020 through April 2021 at the University of Virginia Medical Center.Patients 342 critically-ill adults that were 63.5% male with median age 60.8 years, median weight 79.1 kg, and median body mass index of 27.5 kg/m2.Interventions Real-world testing of our validated predictive model as a clinical decision support tool for ICU hypoglycemia.Measurements and Main Results We retrospectively reviewed 350 hypothetical alerts that met inclusion criteria for analysis. The alerts correctly predicted 48 cases of Level 1 hypoglycemia that occurred ≥1 and ≤12 hours after the alert threshold was met (positive predictive value= 13.7%). Twenty-one of these 48 cases (43.8%) involved Level 2 hypoglycemia. Notably, three myocardial infarctions, one medical emergency team call, two initiations of cardiopulmonary resuscitation, 6 unplanned surgeries, 19 deaths, 20 arrhythmias, and 38 blood or urine cultures were identified or obtained ≥1 and ≤12 hours after an alert threshold was met. Alerts identified 102 total events of hypoglycemia and/or clinical deterioration, yielding a positive predictive value for any event of 29.1%.Conclusions Alerts generated by a validated ICU hypoglycemia prediction model had positive predictive value of 29.1% for hypoglycemia and other associated adverse clinical events.Key Points Question What are the accuracy of and clinical events associated with a risk alert threshold for ICU hypoglycemia?Findings We retrospectively reviewed 350 hypothetical alerts that correctly predicted 48 cases of Level 1 hypoglycemia occurring ≥1 and ≤12 hours after the alert threshold was met (positive predictive value= 13.7%). Notably, three myocardial infarctions, one medical emergency team call, two initiations of cardiopulmonary resuscitation, 6 unplanned surgeries, 19 deaths, 20 arrhythmias, and 38 blood or urine cultures were identified or obtained ≥1 and ≤12 hours after an alert threshold was met.Meaning Alerts generated by a validated ICU hypoglycemia prediction model had positive predictive value of 29.1% for hypoglycemia and other associated adverse clinical events. | ||
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| 700 | 1 | |a Chaney, Cherie R. |e verfasserin |4 aut | |
| 700 | 1 | |a Krahn, Katy N. |e verfasserin |4 aut | |
| 700 | 1 | |a Chernyavskiy, Pavel |e verfasserin |4 aut | |
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