Abstract
Objective: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. Design, setting and participants: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. Main outcome measures: Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). Results: Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% Cl, 0.49–0.60), and for proximate cause of death List B, kappa was 0.58 (95% Cl, 0.53–0.63). For the underlying cause of death, kappa was 0.48 (95% Cl, 0.44–0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%–93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%–92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%–81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. Conclusions: The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.
| Original language | English |
|---|---|
| Pages (from-to) | 50-54 |
| Number of pages | 5 |
| Journal | Critical Care and Resuscitation |
| Volume | 18 |
| Issue number | 1 |
| Publication status | Published - Mar 2016 |
Cite this
}
Validation of a classification system for causes of death in critical care : An assessment of inter-rater reliability. / Ridgeon, Elliott; Bellomo, Rinaldo; Myburgh, John; Saxena, Manoj; Weatherall, Mark; Jahan, Rahi; Arawwawala, Dilshan; Bell, Stephen; Butt, Warwick; Camsooksai, Julie; Carle, Coralie; Cheng, Andrew; Cirstea, Emanuel; Cohen, Jeremy; Cranshaw, Julius; Delaney, Anthony; Eastwood, Glenn; Eliott, Suzanne; Franke, Uwe; Gantner, Dashiell; Newby, Lynette; Shehabi, Yahya; ICU-DECLARE Investigators.
In: Critical Care and Resuscitation, Vol. 18, No. 1, 03.2016, p. 50-54.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Validation of a classification system for causes of death in critical care
T2 - An assessment of inter-rater reliability
AU - Ridgeon, Elliott
AU - Bellomo, Rinaldo
AU - Myburgh, John
AU - Saxena, Manoj
AU - Weatherall, Mark
AU - Jahan, Rahi
AU - Arawwawala, Dilshan
AU - Bell, Stephen
AU - Butt, Warwick
AU - Camsooksai, Julie
AU - Carle, Coralie
AU - Cheng, Andrew
AU - Cirstea, Emanuel
AU - Cohen, Jeremy
AU - Cranshaw, Julius
AU - Delaney, Anthony
AU - Eastwood, Glenn
AU - Eliott, Suzanne
AU - Franke, Uwe
AU - Gantner, Dashiell
AU - Newby, Lynette
AU - Shehabi, Yahya
AU - ICU-DECLARE Investigators
PY - 2016/3
Y1 - 2016/3
N2 - Objective: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. Design, setting and participants: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. Main outcome measures: Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). Results: Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% Cl, 0.49–0.60), and for proximate cause of death List B, kappa was 0.58 (95% Cl, 0.53–0.63). For the underlying cause of death, kappa was 0.48 (95% Cl, 0.44–0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%–93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%–92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%–81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. Conclusions: The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.
AB - Objective: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. Design, setting and participants: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. Main outcome measures: Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). Results: Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% Cl, 0.49–0.60), and for proximate cause of death List B, kappa was 0.58 (95% Cl, 0.53–0.63). For the underlying cause of death, kappa was 0.48 (95% Cl, 0.44–0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%–93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%–92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%–81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. Conclusions: The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.
UR - http://www.scopus.com/inward/record.url?scp=84983001574&partnerID=8YFLogxK
M3 - Article
VL - 18
SP - 50
EP - 54
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
SN - 1441-2772
IS - 1
ER -