Fernandez Rafael, Baigorri Francisco, Navarro Gema, Artigas Antonio
Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n, 08208, Sabadell, Spain.
Crit Care. 2006;10(6):R179. doi: 10.1186/cc5136.
Mortality in the ward after an intensive care unit (ICU) stay is considered a quality parameter, and is described as a source of avoidable mortality. Additionally, the attending intensivist frequently anticipates fatal outcome after ICU discharge. Our objective was to test the ability of a new score to stratify patients according to ward mortality after ICU discharge.
A prospective cohort study was performed in the general ICU of a university-affiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome.
We studied 1,521 patients with a mean age of 60.2 +/- 17.8 years. The median (25-75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. Post-ICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84-0.93) for the Sabadell score.
The Sabadell score at ICU discharge works effectively to stratify patients according to hospital outcome.
重症监护病房（ICU）住院后在病房内的死亡率被视为一项质量参数，并被描述为可避免死亡的一个来源。此外，主治重症监护医生常常能预见到ICU出院后的致命结局。我们的目的是测试一种新评分根据ICU出院后病房死亡率对患者进行分层的能力。
在一所大学附属医院的综合ICU进行了一项前瞻性队列研究。在2003年和2004年，我们前瞻性地记录了主治重症监护医生在ICU出院时对每位入住ICU患者的医院结局的主观预后（萨瓦德尔评分），随后将其与实际医院结局进行比较。
我们研究了1521例患者，平均年龄为60.2±17.8岁。ICU住院时间的中位数（第25 - 75百分位数）为5（3至9）天。ICU死亡率为23.8%，1156例患者出院至病房。ICU后病房死亡率为9.6%，主要见于萨瓦德尔评分为3分（81.3%）或2分（41.1%）的患者，而评分为1分（17.2%）和0分（1.7%）的患者死亡率较低。多因素分析选择年龄和萨瓦德尔评分作为与病房死亡率相关的仅有的变量，萨瓦德尔评分的受试者工作特征曲线下面积为0.88（95%CI 0.84 - 0.93）。
ICU出院时的萨瓦德尔评分能有效地根据医院结局对患者进行分层。
