运用罗特曼指数预测早期非计划性转入外科重症监护病房的再入院情况。
Using the Rothman index to predict early unplanned surgical intensive care unit readmissions.
机构信息
From the Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
出版信息
J Trauma Acute Care Surg. 2014 Jul;77(1):78-82. doi: 10.1097/TA.0000000000000265.
BACKGROUND
The Rothman index (RI) is a numerical score calculated hourly from 26 data points in the electronic medical record by a commercial software package. Although it is purported to serve as an indicator of change in a patient's condition, it has not been extensively evaluated in the literature. Our objective was to determine whether the RI can be used to predict early surgical intensive care unit (SICU) readmissions.
METHODS
This is a single-institution, retrospective 12-month period review of all patients transferred from the SICU to the surgical floor. Patients readmitted to the SICU within 48 hours were compared with patients who did not require readmission during this time (control). Demographics and continuous RI scores were collected at admission, 24 hours before SICU transfer, and for the first 48 hours on the surgical floor or until readmission to the SICU.
RESULTS
A total of 1,152 SICU patients were transferred to the surgical floor; 27 patients were readmitted within 48 hours of transfer. Demographics were similar in both groups. The SICU length of stay was longer in the readmission group (mean [SD], 4.7 [8.1] vs. 16.5 [15.2]; p < 0.001). The RI immediately before SICU transfer was higher in the control group (70.4 [20.3] vs. 49.1 [20.9], p < 0.001) and was uniformly improved from the RI at the initial SICU admission. In comparison, readmitted patients had more variable RI trends from admission to SICU transfer (mean Δ, 6.51; range, -54.10 to 48.6), and 40.74% of readmitted patients actually had a decreased RI score on transfer. No patient with a RI score greater than 82.90 required readmission within 48 hours.
CONCLUSION
An increased RI score or a score greater than 82.90 correlates with appropriateness for SICU transfer to the surgical floor. A decreased RI score is strongly associated with SICU readmission within 48 hours and should be explored as a potential quality metric.
LEVEL OF EVIDENCE
Epidemiologic/prognostic study, level III.
背景
罗思曼指数（RI）是一种数值评分，通过商业软件包从电子病历中的 26 个数据点每小时计算一次。尽管它被认为是患者病情变化的指标，但在文献中尚未得到广泛评估。我们的目的是确定 RI 是否可用于预测早期外科重症监护病房（SICU）再入院。
方法
这是一项单中心、回顾性的 12 个月期间对所有从 SICU 转至外科病房的患者进行的研究。将在 48 小时内再次入住 SICU 的患者与在此期间无需再次入院的患者（对照组）进行比较。在入院时、SICU 转院前 24 小时以及外科病房的前 48 小时或直至再次入住 SICU 时，收集患者的人口统计学和连续 RI 评分。
结果
共有 1152 例 SICU 患者转至外科病房；27 例患者在转院后 48 小时内再次入院。两组患者的人口统计学特征相似。再入院组的 SICU 住院时间较长（平均[标准差]，4.7[8.1]比 16.5[15.2]；p<0.001）。对照组在 SICU 转院前的 RI 更高（70.4[20.3]比 49.1[20.9]；p<0.001），并且从最初的 SICU 入院开始，RI 就一直得到改善。相比之下，再入院患者从入院到 SICU 转院前的 RI 趋势变化更大（平均Δ，6.51；范围，-54.10 至 48.6），并且 40.74%的再入院患者在转院前的 RI 评分实际上降低了。没有 RI 评分大于 82.90 的患者在 48 小时内再次入院。
结论
RI 评分增加或评分大于 82.90 与 SICU 转至外科病房的适宜性相关。RI 评分降低与 48 小时内 SICU 再入院强烈相关，应作为潜在的质量指标进行探讨。
证据水平
流行病学/预后研究，III 级。
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