The Department of Anesthesia and Critical Care Medicine, George Washington University, Washington, DC, USA.
J Crit Care. 2010 Jun;25(2):205-13. doi: 10.1016/j.jcrc.2009.06.010. Epub 2009 Aug 13.
This study presents a new model for identifying patients who might be too well to benefit from intensive care unit (ICU) care.
Intensive care unit admissions in 2002 to 2003 were used to develop a model to predict whether patients monitored on day one would receive one or more of 33 subsequent active life-supporting treatments. Accuracy was assessed by testing the model in a subsequent cohort of admissions in 2004 to 2006. We then assessed the frequency of active treatment among monitor patients at a low (<10%) risk for active life-supporting therapy on ICU day 1.
Among 28 847 ICU monitor admissions in 2004 to 2006, 3153 patients (11.0%) were predicted to receive active treatment; 3296 (11.5%) actually did. There were 17 720 admissions with a low (<10%) risk for receiving subsequent active life-supporting treatment; 1238 (7.0%) received subsequent active treatment. Hospital mortality (2.5%) and mean ICU stay (1.8 days) suggests that most of these patients did not require ICU care.
The outcome for low-risk monitor patients suggest they may be too well to benefit from intensive care. The frequency of low-risk monitor admissions provides a measure of ICU resource use. Improved resource use and reduced costs might be achieved by strategies to provide care for these patients on floors or intermediate care units.
本研究提出了一种新的模型，用于识别那些可能因重症监护病房（ICU）治疗而受益的患者。
使用 2002 年至 2003 年的 ICU 入院数据来开发一种模型，以预测在第一天接受监测的患者是否会接受 33 种后续积极的生命支持治疗中的一种或多种治疗。通过在 2004 年至 2006 年的后续入院队列中测试该模型来评估准确性。然后，我们评估了在 ICU 第 1 天处于低（<10%）风险的监测患者中进行积极治疗的频率。
在 2004 年至 2006 年的 28847 例 ICU 监测入院中，有 3153 例（11.0%）患者预计会接受积极治疗；实际上有 3296 例（11.5%）患者接受了治疗。有 17720 例入院患者处于接受后续积极生命支持治疗的低（<10%）风险；其中 1238 例（7.0%）接受了后续积极治疗。住院死亡率（2.5%）和平均 ICU 住院时间（1.8 天）表明，这些患者中的大多数并不需要 ICU 护理。
低风险监测患者的结果表明，他们可能因病情过重而无法从重症监护中受益。低风险监测入院的频率提供了 ICU 资源使用的衡量标准。通过为这些患者提供楼层或中间护理单元的护理策略，可能实现改善资源利用和降低成本的目标。
