Inconsistencies in respiratory system scores between first_day_sofa.sql and sofa.sql

[weilidr]

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Description

Description of the issue, including:

Greetings!

• [1] I have identified an inconsistency between first_day_sofa.sql and sofa.sql concerning the calculation of respiratory system scores. Specifically, first_day_sofa.sql does not restrict the respiratory system scores to records where specimen = 'ART.'

sofa.sql is

pafi AS (
  /* join blood gas to ventilation durations to determine if patient was vent */
  SELECT
    ie.stay_id,
    bg.charttime, /* because pafi has an interaction between vent/PaO2:FiO2, */ /* we need two columns for the score */ /* it can happen that the lowest unventilated PaO2/FiO2 is 68, */ /* but the lowest ventilated PaO2/FiO2 is 120 */ /* in this case, the SOFA score is 3, *not* 4. */
    CASE WHEN vd.stay_id IS NULL THEN pao2fio2ratio ELSE NULL END AS pao2fio2ratio_novent,
    CASE WHEN NOT vd.stay_id IS NULL THEN pao2fio2ratio ELSE NULL END AS pao2fio2ratio_vent
  FROM mimiciv_icu.icustays AS ie
  INNER JOIN mimiciv_derived.bg AS bg
    ON ie.subject_id = bg.subject_id
  LEFT JOIN mimiciv_derived.ventilation AS vd
    ON ie.stay_id = vd.stay_id
    AND bg.charttime >= vd.starttime
    AND bg.charttime <= vd.endtime
    AND vd.ventilation_status = 'InvasiveVent'
  WHERE
    specimen = 'ART.'
)

while first_day_sofa.sql is missing the restriction for arterial pO2, specifically WHERE specimen = 'ART.'

pafi1 AS (
  /* join blood gas to ventilation durations to determine if patient was vent */
  SELECT
    ie.stay_id,
    bg.charttime,
    bg.pao2fio2ratio,
    CASE WHEN NOT vd.stay_id IS NULL THEN 1 ELSE 0 END AS isvent
  FROM mimiciv_icu.icustays AS ie
  LEFT JOIN mimiciv_derived.bg AS bg
    ON ie.subject_id = bg.subject_id
    AND bg.charttime >= ie.intime - INTERVAL '6 HOUR'
    AND bg.charttime <= ie.intime + INTERVAL '1 DAY'
  LEFT JOIN mimiciv_derived.ventilation AS vd
    ON ie.stay_id = vd.stay_id
    AND bg.charttime >= vd.starttime
    AND bg.charttime <= vd.endtime
    AND vd.ventilation_status = 'InvasiveVent'
)

• [2] Regarding the restriction of vd.ventilation_status = 'InvasiveVent'
  I am confused about whether the respiratory support in the SOFA score includes only invasive mechanical ventilation, why not include vd.ventilation_status = 'NonInvasiveVent'? Non-invasive mechanical ventilation also provides respiratory support, yet the original SOFA literature seems to lack a clear definition of what constitutes respiratory support. Interestingly, the Berlin definition for ARDS appears to include non-invasive mechanical ventilation as well.
  Which one is more appropriate?
  vd.ventilation_status = 'InvasiveVent
v.ventilation_status in ('InvasiveVent', 'NonInvasiveVent')
v.ventilation_status in ('InvasiveVent', 'Tracheostomy', 'NonInvasiveVent')

Thank you for your attention to this matter!