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1 February 1995 | Volume 122 Issue 3 | Pages 191-203
Objective: To develop and validate a prognostic model that estimates survival over a 180-day period for seriously ill hospitalized adults (phase I of SUPPORT [Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments]) and to compare this model's predictions with those of an existing prognostic system and with physicians' independent estimates (SUPPORT phase II).
Design: Prospective cohort study.
Setting: 5 tertiary care academic centers in the United States.
Participants: 4301 hospitalized adults were selected for phase I according to diagnosis and severity of illness; 4028 patients were evaluated from phase II.
Measurements: A survival model was developed using the following predictor variables: diagnosis, age, number of days in the hospital before study entry, presence of cancer, neurologic function, and 11 physiologic measures recorded on day 3 after study entry. Physicians were interviewed on day 3. Patients were followed for survival for 180 days after study entry.
Results: The area under the receiver-operating characteristics (ROC) curve for prediction of surviving 180 days was 0.79 in phase I, 0.78 in the phase II independent validation, and 0.78 when the acute physiology score from the APACHE (Acute Physiology, Age, Chronic Health Evaluation) III prognostic scoring system was substituted for the SUPPORT physiology score. For phase II patients, the SUPPORT model had equal discrimination and slightly improved calibration compared with physicians' estimates. Combining the SUPPORT model with physicians' estimates improved both predictive accuracy (ROC curve area = 0.82) and the ability to identify patients with high probabilities of survival or death.
Conclusions: A limited amount of readily available clinical information can provide a foundation for long-term survival estimates that are as accurate as physicians' estimates. The best survival estimates combine an objective prognosis with a physician's clinical estimate.
Author and Article Information
From the George Washington University Medical Center, Washington, D.C.; Duke University Medical Center, Durham, North Carolina; Dartmouth Medical School, Hanover, New Hampshire; Beth Israel Hospital, Boston, Massachusetts; Metrohealth Medical Center, Cleveland, Ohio; Marshfield Medical Research Foundation and the Marshfield Clinic, Marshfield, Wisconsin; and University of California, Los Angeles, School of Medicine, Los Angeles, California.
ACADEMIA AND CLINIC
The SUPPORT Prognostic Model: Objective Estimates of Survival for Seriously Ill Hospitalized Adults
Requests for Reprints: William A. Knaus, MD, National Coordinating Center, The Robert Wood Johnson Foundation Critically Ill Hospitalized Adult Program, ICU Research Unit, 2300 K Street NW, Washington, DC 20037.
Grant Support: By The Robert Wood Johnson Foundation. The opinions and findings contained in this article are those of the authors and do not necessarily represent the views of The Robert Wood Johnson Foundation or their Board of Trustees.
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