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. 2023 Nov 4;4(2):216-221.
doi: 10.1016/j.jointm.2023.09.003. eCollection 2024 Apr.

Diagnostic accuracy of ePOS score in predicting DNR labeling after ICU admission: A prospective observational study (ePOS-DNR)

Omar E Ramadan  1   2 , Ahmed F Mady  1   3 , Mohammed A Al-Odat  1 , Ahmed N Balshi  1 , Ahmed W Aletreby  4 , Taisy J Stephen  1   5 , Sheena R Diolaso  1   5 , Jennifer Q Gano  1   5 , Waleed Th Aletreby  1
Affiliations

Diagnostic accuracy of ePOS score in predicting DNR labeling after ICU admission: A prospective observational study (ePOS-DNR)

Omar E Ramadan et al. J Intensive Med. .

Abstract

Background: Resuscitation can sometimes be futile and making a do-not-resuscitate (DNR) decision is in the best interest of the patient. The electronic poor outcome screening (ePOS) score was developed to predict 6-month poor outcomes of critically ill patients. We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit (ICU).

Methods: This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023. Prospectively, we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders. The ability of the score to predict DNR was explored using logistic regression. Youden's ideal cut-off value was calculated using the DeLong method, and different diagnostic accuracy measures were generated with corresponding 95 % confidence intervals (CIs).

Results: We enrolled 857 patients, 125 received a DNR order and 732 did not. The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7, respectively. ePOS score, as a predictor of DNR order, had an area under receiver operator characteristic (AUROC) curve of 81.8 % (95% CI: 79.0 to 84.3, P <0.001). Youden's ideal cut-off value >17 was associated with a sensitivity of 87.2 (95% CI: 80.0 to 92.5, P <0.001), specificity of 63.9 (95% CI: 60.3 to 67.4, P <0.001), positive predictive value of 29.2 (95% CI: 24.6 to 33.8, P <0.001), negative predictive value of 96.7 (95% CI: 95.1 to 98.3, P <0.001), and diagnostic odds ratio 12.1 (95% CI: 7.0 to 20.8, P <0.001).

Conclusions: In this study, the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay. A cut-off score >17 may help guide clinical decisions to withhold or commence resuscitative measures.

Keywords: Diagnostic accuracy; Do-not-resuscitate (DNR); Intensive care unit (ICU); Resuscitation; Sensitivity; Specificity.

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Figures

Figure 1
Figure 1
Flow diagram of patient enrollment. DNR: Do not resuscitate; ICU: Intensive care unit; LOS: Length of stay.
Figure 2
Figure 2
AUROC curve for diagnostic accuracy. AUROC: Area under receiver operator characteristic; CI: Confidence interval.
Figure 3
Figure 3
Calibration belt for electronic poor outcome screening score prediction.
See this image and copyright information in PMC

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