Why the C-statistic is not informative to evaluate early warning scores and what metrics to use

Santiago Romero-Brufau, Jeanne M. Huddleston, Gabriel J. Escobar, Mark Liebow

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

Metrics typically used to report the performance of an early warning score (EWS), such as the area under the receiver operator characteristic curve or C-statistic, are not useful for pre-implementation analyses. Because physiological deterioration has an extremely low prevalence of 0.02 per patient-day, these metrics can be misleading. We discuss the statistical reasoning behind this statement and present a novel alternative metric more adequate to operationalize an EWS. We suggest that pre-implementation evaluation of EWSs should include at least two metrics: sensitivity; and either the positive predictive value, number needed to evaluate, or estimated rate of alerts. We also argue the importance of reporting each individual cutoff value.

Original languageEnglish (US)
Article number285
JournalCritical Care
Volume19
Issue number1
DOIs
StatePublished - Aug 13 2015

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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