Rosenberg A L, Hofer T P, Hayward R A, Strachan C, Watts C M
Robert Wood Johnson Clinical Scholars Program, the Department of Anesthesiology and Critical Care Medicine, The University of Michigan Health System, Ann Arbor, MI, USA.
Crit Care Med. 2001 Mar;29(3):511-8. doi: 10.1097/00003246-200103000-00008.
To determine the influence of changes in acute physiology scores (APS) and other patient characteristics on predicting intensive care unit (ICU) readmission.
Secondary analysis of a prospective cohort study.
Single large university medical intensive care unit.
A total of 4,684 consecutive admissions from January 1, 1994, to April 1, 1998, to the medical ICU.
None.
The independent influence of patient characteristics, including daily APS, admission diagnosis, treatment status, and admission location, on ICU readmission was evaluated using logistic regression. After accounting for first ICU admission deaths, 3,310 patients were "at-risk" for ICU readmission and 317 were readmitted (9.6%). Hospital mortality was five times higher (43% vs. 8%; p < .0001), and length of stay was two times longer (16 +/- 16 vs. 32 +/- 28 days; p < .001) in readmitted patients. Mean discharge APS was significantly higher in the readmitted group compared with the not readmitted group (43 +/- 19 vs. 34 +/- 18; p > .01). Significant independent predictors of ICU readmission included discharge APS >40 (odds ratio [OR] 2.1; 95% confidence interval [CI] 1.6-2.7; p < .0001), admission to the ICU from a general medicine ward (Floor) (OR 1.9; 95% CI 1.4-2.6; p < .0001), and transfer to the ICU from other hospital (Transfer) (OR 1.7; 95% CI 1.3-2.3; p < .01). The overall model calibration and discrimination were (H-L chi2 = 3.8, df = 8; p = .85) and (receiver operating characteristic 0.67), respectively.
Patients readmitted to medical ICUs have significantly higher hospital lengths of stay and mortality. ICU readmissions may be more common among patients who respond poorly to treatment as measured by increased severity of illness at first ICU discharge and failure of prior therapy at another hospital or on a general medicine unit. Tertiary care ICUs may have higher than expected readmission rates and mortalities, even when accounting for severity of illness, if they care for significant numbers of transferred patients.
确定急性生理学评分(APS)变化及其他患者特征对预测重症监护病房(ICU)再入院的影响。
前瞻性队列研究的二次分析。
一所大型大学医学重症监护病房。
1994年1月1日至1998年4月1日期间连续入住该医学ICU的4684例患者。
无。
采用逻辑回归评估患者特征(包括每日APS、入院诊断、治疗状态及入院科室)对ICU再入院的独立影响。排除首次入住ICU死亡的患者后,3310例患者有ICU再入院风险,其中317例再次入院(9.6%)。再入院患者的医院死亡率高出5倍(43%对8%;p<0.0001),住院时间长2倍(16±16天对32±28天;p<0.001)。再入院组出院时的平均APS显著高于未再入院组(43±19对34±18;p>0.01)。ICU再入院的显著独立预测因素包括出院时APS>40(比值比[OR]2.1;95%置信区间[CI]1.6 - 2.7;p<0.0001)、从普通内科病房转入ICU(OR 1.9;95%CI 1.4 - 2.6;p<0.0001)以及从其他医院转入ICU(OR 1.7;95%CI 1.3 - 2.3;p<0.01)。总体模型的校准度和区分度分别为(H - L卡方 = 3.8,自由度 = 8;p = 0.85)和(受试者工作特征曲线下面积为0.67)。
入住医学ICU后再入院的患者住院时间和死亡率显著更高。以首次ICU出院时病情严重程度增加以及在另一家医院或普通内科病房先前治疗失败衡量,对治疗反应不佳的患者中ICU再入院可能更常见。三级医疗ICU如果收治大量转院患者,即使考虑了病情严重程度,其再入院率和死亡率可能也高于预期。