-
Tytuł:
-
Predicting early deterioration of admitted patients at the Intermediate Care Unit.
-
Autorzy:
-
Plate JDJ; Division of Surgery, University Medical Centre Utrecht, Utrecht University, The Netherlands. Electronic address: .
Hietbrink F; Division of Surgery, University Medical Centre Utrecht, Utrecht University, The Netherlands.
Leenen LPH; Division of Surgery, University Medical Centre Utrecht, Utrecht University, The Netherlands.
Peelen LM; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands; Departments of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
-
Źródło:
-
Journal of critical care [J Crit Care] 2018 Dec; Vol. 48, pp. 97-103. Date of Electronic Publication: 2018 Aug 16.
-
Typ publikacji:
-
Journal Article
-
Język:
-
English
-
Imprint Name(s):
-
Publication: Philadelphia Pa : W.B. Saunders
Original Publication: Orlando, FL : Grune & Stratton, c1986-
-
MeSH Terms:
-
Intermediate Care Facilities*
Triage*
Diuresis/*physiology
Respiratory Insufficiency/*diagnosis
Sepsis/*diagnosis
Adult ; Aged ; Critical Illness ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Respiratory Insufficiency/mortality ; Respiratory Insufficiency/physiopathology ; Retrospective Studies ; Sepsis/mortality ; Sepsis/physiopathology
-
Contributed Indexing:
-
Keywords: Critical care optimisation; Early clinical deterioration; High Dependency Unit; Intermediate Care Unit; Triage at admission; Under-triage
-
Entry Date(s):
-
Date Created: 20180904 Date Completed: 20191017 Latest Revision: 20191017
-
Update Code:
-
20240104
-
DOI:
-
10.1016/j.jcrc.2018.08.012
-
PMID:
-
30176530
-
Purpose: Under-triage is a major threat when admitting patients at the Intermediate Care Unit (IMCU). This study aims to identify risk factors and predict early deterioration of IMCU admissions, to reduce the risk of under-triage.
Materials and Methods: This retrospective cohort study included all admissions to the mixed-surgical stand-alone IMCU of a tertiary referral hospital (2001-2015). Variables included were age, sex, admission indication, admitting specialty, re-admission, and nursing interventions. Early clinical deterioration was defined as ICU transfer or death ≤24 h of admission. Multinomial and logistic regression analyses were performed to identify risk factors and obtain predictions, for several frequently encountered subgroups.
Results: A total of 9103 admissions were included, of which 350 (3.8%) early deteriorated. Patients admitted for hemodynamic and respiratory instability had a high risk of early deterioration (OR 16.3 (CI 4.5-59.1)), probability 47.1%. Patients admitted with respiratory insufficiency and active diuresis or complicated sepsis had a high probability of early deterioration (≥29% and ≥26% respectively). The model had an optimism-corrected c-statistic of 0.79 (IQR 0.78-0.80).
Conclusions: Patients with combined hemodynamic and respiratory instability should not be admitted to the IMCU. Patients with respiratory insufficiency and active diuresis, or complicated sepsis require close monitoring.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
