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Tytuł:
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Early in-hospital clinical deterioration is not predicted by severity of illness, functional status, or comorbidity.
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Autorzy:
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Wang J; Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park.
Hahn SS; Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park.
Kline M; Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
Cohen RI; Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park.
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Źródło:
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International journal of general medicine [Int J Gen Med] 2017 Sep 29; Vol. 10, pp. 329-334. Date of Electronic Publication: 2017 Sep 29 (Print Publication: 2017).
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: [Auckland, N.Z.] : Dove Medical Press, c2008-
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References:
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Contributed Indexing:
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Keywords: clinical deterioration; hospital admission; medical error; palliative care; rapid response team; triage
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Entry Date(s):
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Date Created: 20171017 Latest Revision: 20201001
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Update Code:
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20240105
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PubMed Central ID:
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PMC5628698
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DOI:
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10.2147/IJGM.S145933
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PMID:
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29033602
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Background: Prior studies concentrated on unplanned intensive care unit (ICU) transfer to gauge deterioration occurring shortly following hospital admission. However, examining only ICU transfers is not ideal since patients could stabilize with treatment, refuse ICU admission, or not require ICU evaluation. To further explore etiologies of early clinical deterioration, we used rapid response team (RRT) activation within 48 hours of admission as an index of early clinical worsening.
Methods: A retrospective analysis of prospectively gathered admissions from the emergency department in an academic medical center was done. Data were reviewed independently by two physicians. We assessed severity of illness, functional status, comorbidity, the frequency of ICU and palliative care consultations, and changes in advance health care directives.
Results: Of 655 rapid responses (RRs) within the study period, 24.6% occurred within 48 hours of admission. Disease trajectory was the most frequent perceived reason for RRs (55.6% and 58.9%, reviewer 1 and 2, respectively) followed by medical error (15.6% and 15.2%). Acute physiology and chronic health evaluation II (APACHE-II) and modified early warning scores (MEWS) were higher at the time of RR compared to admission ( p <0.0001). However, admission APACHE-II, MEWS, functional status, and comorbidity scores did not predict early RRs. One third of RRs resulted in ICU consultation and 95% were accepted. Palliative care consults were requested for 15%, the majority (65%) after RR and all resulting in advance directive change.
Conclusion: Disease trajectory accounted for most clinical deterioration and medical error contributed to 15%. Our data suggest that it is difficult to predict early clinical deterioration as none of the measured parameters were associated with RRT activation.
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
