Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
J Intensive Care Med. 2020 Oct;35(10):1067-1073. doi: 10.1177/0885066618811810. Epub 2018 Nov 26.
To describe factors (demographics and clinical characteristics) that predict patients who are at an increased risk of adverse events or unplanned return visits to a health-care facility following discharge direct to home (DDH) from intensive care units (ICUs).
Prospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between February 2016 and 2017 and were discharged directly home. Patients were followed for 8 weeks postdischarge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with adverse events or unplanned return visits to a health-care facility following DDH from ICU.
A total of 129 DDH patients were enrolled and completed the 8-week follow-up. We identified 39 unplanned return visits (URVs). There was 0% mortality at 8 weeks postdischarge. Eight potential predictors of hospital URVs ( < .2) were identified in the univariable analysis: prior substance abuse (odds ratio [OR] of URV of 2.50 [95% confidence interval: 1.08-5.80], hepatitis (OR: 6.92 [1.68-28.48]), sepsis (OR: 11.03 [1.19-102.29]), admission nine equivalents of nursing manpower score (NEMS) <24 (OR: 2.28 [1.03-5.04], no fixed address (OR: 22.9 [1.2-437.3]), ICU length of stay (LOS) <2 days (OR: 2.95 [1.28-6.78]), home discharge within London, Ontario (OR: 2.44 [1.00-5.92]), and left against medical advice (AMA; OR: 6.06 [2.04-17.98]).
Our study identified 8 covariates that were potential predictors of URV: prior substance abuse, hepatitis, sepsis, admission NEMS <24, no fixed address, ICU LOS <2 days, home discharge within London, Ontario, and left AMA. The practice of direct discharges home from the ICU would benefit from adequately powered multicenter study in order to construct a clinical prediction model (that would require further testing and validation).
描述预测患者在从重症监护病房（ICU）直接出院后发生不良事件或计划外返院就诊的风险增加的因素（人口统计学和临床特征）。
这是一项前瞻性队列研究，纳入了 2016 年 2 月至 2017 年期间在我们的内科-外科-创伤 ICU 存活并直接出院回家的所有成年患者。患者在出院后 8 周内接受随访。采用单变量和多变量逻辑回归分析确定与 ICU 直接出院后发生不良事件或计划外返院就诊相关的因素。
共纳入 129 例直接出院的患者并完成了 8 周的随访。我们发现有 39 例计划外返院就诊（URV）。出院后 8 周时无死亡病例。单变量分析中确定了 8 个可能预测医院 URV 的因素（<0.2）：既往药物滥用（URV 的优势比 [OR]为 2.50 [95%置信区间：1.08-5.80]）、肝炎（OR：6.92 [1.68-28.48]）、败血症（OR：11.03 [1.19-102.29]）、入院时护理人力评分（NEMS）<24（OR：2.28 [1.03-5.04]）、无固定地址（OR：22.9 [1.2-437.3]）、ICU 住院时间（LOS）<2 天（OR：2.95 [1.28-6.78]）、在安大略省伦敦市出院（OR：2.44 [1.00-5.92]）和擅自离院（OR：6.06 [2.04-17.98]）。
我们的研究确定了 8 个可能预测 URV 的协变量：既往药物滥用、肝炎、败血症、入院时 NEMS<24、无固定地址、ICU LOS<2 天、在安大略省伦敦市出院和擅自离院。直接从 ICU 出院的做法需要通过具有足够效力的多中心研究来受益，以便构建临床预测模型（这需要进一步的测试和验证）。
