创伤患者的重症监护病房反弹：对非计划性返回重症监护病房的分析。
Intensive care unit bounce back in trauma patients: an analysis of unplanned returns to the intensive care unit.
机构信息
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina 29245, USA.
出版信息
J Trauma Acute Care Surg. 2013 Jun;74(6):1528-33. doi: 10.1097/TA.0b013e31829247e7.
BACKGROUND
Discharging patients from the intensive care unit (ICU) often requires complex decision making to balance patient needs with available resources. Unplanned return to the ICU ("bounce back" [BB]) has been associated with increased resource use and worse outcomes, but few data on trauma patients are available. The goal of this study was to review ICU BB and define ICU discharge variables that may be predictive of BB.
METHODS
Adults admitted to ICU and discharged alive to a ward from November 04, 2012, to September 9, 2012 (interval with no changes in coverage), were selected from our trauma registry. Patients with unplanned return to ICU (BB cases) were matched 1:2 with controls on age, Injury Severity Score (ISS), and duration of post-ICU stay. Data were collected by chart review then analyzed with univariate and conditional multivariate techniques.
RESULTS
Of 8,835 hospital admissions, 1,971 (22.3%) were discharged alive from ICU to a ward. Eighty-eight patients (4.5%) met our criteria for BB (male, 75%; mean [SD] age, 52.9 [21.9] years; mean [SD] ISS, 23.1 [10.2]). Most (71.6%) occurred within 72 hours. Mortality for BB cases was high (19.3%). Regression analysis showed that male sex (odds ratio, 2.9; p = 0.01), Glasgow Coma Scale [GCS] score of less than 9 (odds ratio, 22.3; p < 0.01), discharge during day shift (odds ratio, 6.9; p < 0.0001), and presence of one (odds ratio, 3.5; p = 0.03), two (odds ratio, 3.8; p = 0.03), or three or more comorbidities (odds ratio, 8.4; p < 0.001) were predictive of BB.
CONCLUSION
In this study, BB rate was 4.8%, and associated mortality was 19.3%. At the time of ICU discharge, male sex, a GCS score of less than 9, higher FIO2, discharge on day shift, and presence of one or more comorbidities were the strongest predictors of BB. A multi-institutional study is needed to validate and extend these results.
LEVEL OF EVIDENCE
Epidemiologic/prognostic study, level IV.
背景
从重症监护病房（ICU）出院通常需要进行复杂的决策，以平衡患者需求和可用资源。计划外返回 ICU（“反弹”[BB]）与资源使用增加和预后恶化有关，但关于创伤患者的数据很少。本研究的目的是回顾 ICU BB，并确定可能预测 BB 的 ICU 出院变量。
方法
从我们的创伤登记处选择 2012 年 11 月 4 日至 9 月 9 日期间（没有覆盖范围变化的间隔）入住 ICU 并存活出院到病房的成年人。对计划外返回 ICU（BB 病例）的患者进行年龄、损伤严重程度评分（ISS）和 ICU 后住院时间的 1:2 匹配对照。通过图表审查收集数据，然后使用单变量和条件多变量技术进行分析。
结果
在 8835 例住院患者中，有 1971 例（22.3%）从 ICU 存活出院至病房。88 例（4.5%）符合我们的 BB 标准（男性，75%；平均[SD]年龄，52.9[21.9]岁；平均[SD]ISS，23.1[10.2]）。大多数（71.6%）发生在 72 小时内。BB 病例的死亡率很高（19.3%）。回归分析显示，男性（优势比，2.9；p = 0.01）、格拉斯哥昏迷评分（GCS）<9（优势比，22.3；p <0.01）、白天班次出院（优势比，6.9；p <0.0001）、存在一种（优势比，3.5；p = 0.03）、两种（优势比，3.8；p = 0.03）或三种或更多合并症（优势比，8.4；p <0.001）是 BB 的预测因素。
结论
在这项研究中，BB 发生率为 4.8%，相关死亡率为 19.3%。在 ICU 出院时，男性、GCS 评分<9、较高的 FIO2、白天班次出院以及存在一种或多种合并症是 BB 的最强预测因素。需要进行多机构研究来验证和扩展这些结果。
证据水平
流行病学/预后研究，IV 级。
Zotero 插件