Table 53Clinical evidence summary: medical outliers

Risk factor and outcome

(population)

Number of studiesEffect (95% CI)ImprecisionGRADE Quality

Outlier versus non-outlier for predicting mortality (hospital mortality)

(congestive heart failure and cardiac arrhythmia patients)a

1Adjusted RR: 0.80 (0.40 to 1.60)SeriousbLOW

Outlier versus non-outlier for predicting mortality (hospital mortality)

(general medical patients)a

1Adjusted RR: 1.41 (1.16 to 1.71)No serious imprecisionMODERATE

Outlier versus non-outlier for predicting mortality (hospital mortality)

(medical and geriatric patients)a

1Adjusted HR: 1.8 (1.28 to 2.53)No serious imprecisionMODERATE

Outlier versus non-outlier for predicting mortality (90 day mortality)

(all admitted patients)a

1RR: 0.75 (0.51 to 1.11)SeriousbVERY LOW

Outlier versus non-outlier for predicting length of stay (days)

(congestive heart failure and cardiac arrhythmia patients)a

1Adjusted mean difference: 2.60 (0.60 to 4.60)No serious imprecisionMODERATE

Outlier versus non-outlier for predicting serious adverse events (infection)

(congestive heart failure and cardiac arrhythmia patients)a

1Adjusted RR: 1.50 (0.80 to 2.81)SeriousbLOW

Outlier versus non-outlier for predicting serious adverse events (haemorrhage)

(congestive heart failure and cardiac arrhythmia patients)a

1Adjusted RR: 1.20 (0.40 to 3.60)SeriousbLOW

Outlier versus non-outlier for predicting serious adverse events (transfer to ICU)

(all admitted patients)a

1RR: 1.05 (0.5 to 2.18)SeriousbVERY LOW
(a)

Methods: multivariable analysis, including key covariates used in analysis to assess if outlier status is an independent risk factor. Key covariates included: age, case-mix, co-morbidities.

(b)

95% CI around the median crosses null line.

From: Chapter 41, Cost-effectiveness analyses

Cover of Emergency and acute medical care in over 16s: service delivery and organisation
Emergency and acute medical care in over 16s: service delivery and organisation.
NICE Guideline, No. 94.
National Guideline Centre (UK).
Copyright © NICE 2018.

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