Prognostic models for predicting intensive care unit admission or mortality in critically ill adults not yet been admitted to the intensive care unit

Clinical Snapshot

Key Findings

• P Value: Not yet reported

• Effect Size: Not yet reported

• Primary Outcome: No results available — this is a protocol only. The primary outcomes planned are ICU admission and mortality (ICU and hospital) within the index hospital admission.

• Nnt Or Sensitivity: Not yet reported — for prognostic models, key metrics will include C-statistic (AUC), calibration slope, calibration-in-the-large, sensitivity, specificity, and positive/negative predictive values at clinically relevant thresholds

• Confidence Interval: Not yet reported

Clinical Application

The completed review will be directly applicable to clinical practice if it identifies validated prognostic models suitable for bedside or electronic health record integration. Feasibility will depend on the data inputs required by identified models (e.g., vital signs, laboratory values, clinical scores) and their compatibility with existing hospital information systems. Many Australian hospitals already use NEWS2 (National Early Warning Score 2) or locally adapted early warning scores, and this review may provide comparative evidence to support or challenge current tool selection. Australia's network of rapid response systems (Medical Emergency Teams, Code Blue systems) and the RACGP/ACEM frameworks for deteriorating patient management make this review highly relevant to Australian practice. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has mandated recognition and response systems under the National Safety and Quality Health Service (NSQHS) Standards. A completed review identifying the most accurate prognostic models could inform updates to these standards and support TGA/ARTG considerations for software-based clinical decision support tools. No specific PBS implications apply, as prognostic scoring tools are not pharmaceutical interventions. RACGP and ACEM guidelines on patient deterioration and escalation of care would be the primary implementation pathways. Critically ill adults presenting to acute hospital wards or emergency departments who have not yet been admitted to the ICU — a population encountered daily in Australian public and private hospitals, particularly in the context of Medical Emergency Team (MET) activations and rapid response system escalations

Abstract

OBJECTIVES: This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: To determine whether prognostic models can be used for predicting the occurrence of ICU admission and mortality within the index hospital admission, and post-discharge survival at reported follow-up time points, up to one year, in critically ill adults not yet admitted to the ICU. The objective in PICOTS format is as follows. POPULATION: critically ill adults not yet admitted to the ICU Index prognostic model: available prognostic models with or without external validation Comparator: not applicable Outcomes: ICU admission, ICU and hospital mortality, and post-discharge survival Timing: for ICU admission or transfer, ICU mortality, and hospital mortality outcomes, the timing will be in hospital. For post-discharge survival, the timing will be up to 28 days, 1 to 3 months, 6 months, and 1 year after hospital discharge. SETTING: acute hospital wards and emergency care departments.

References

1. 1.Vieira, A. G. S., Pinto, A. C. P. N., Garcia, A. A. A., Nawa, R. K., Mól, C. G., Duenas, J., Atallah, Á. N., Shrestha, G. S., Schultz, M. J., Saconato, H., & Trevisani, V. F. M. (2026). Prognostic models for predicting intensive care unit admission or mortality in critically ill adults not yet been admitted to the intensive care unit. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD016115