Medical Sciences PhD program, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil.
Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
J Crit Care. 2019 Jun;51:77-83. doi: 10.1016/j.jcrc.2019.02.002. Epub 2019 Feb 4.
Intensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions.
This was a prospective, before-after study. Urgent ICU referrals to ten ICUs in a tertiary hospital in Brazil were assessed before and after the implementation of the decision-aid tool. Our primary outcome was the proportion of potentially inappropriate ICU referrals (defined as priority 4B or 5 referrals, accordingly to the Society of Critical Care Medicine guidelines of 1999 and 2016, respectively) admitted to the ICU within 48 h. We conducted multivariate analyses to adjust for potential confounders and evaluated the interaction between phase and triage priority.
Of the 2201 patients analyzed, 1184 (53.8%) patients were admitted to the ICU. After adjustment for confounders, implementation of the decision-aid tool was associated with a reduction in potentially inappropriate ICU admissions using either the 1999 [adjOR (95% CI) = 0.36 (0.13-0.97)] or 2016 [adjOR (95%CI) = 0.35 (0.13-0.96)] definitions.
Implementation of a decision-aid tool for ICU triage was associated with a reduction in potentially inappropriate ICU admissions.
重症监护病房（ICU）收治分诊经常发生，且通常涉及到可能存在主观因素的决策，这些决策可能导致不必要的 ICU 收治。本研究旨在评估 ICU 分诊决策辅助工具的实施对 ICU 收治决策的影响。
这是一项前瞻性、前后对照研究。对巴西一家三级医院的 10 个 ICU 的紧急 ICU 转介患者进行了评估，这些患者在实施决策辅助工具之前和之后进行了评估。我们的主要结局是在 48 小时内将潜在不适当的 ICU 转介（根据 1999 年和 2016 年重症监护医学会指南，分别定义为优先级 4B 或 5）收治 ICU 的比例。我们进行了多变量分析以调整潜在混杂因素，并评估了阶段和分诊优先级之间的相互作用。
在分析的 2201 名患者中，有 1184 名（53.8%）患者被收治 ICU。在调整混杂因素后，使用 1999 年[调整后的优势比（95%CI）=0.36（0.13-0.97）]或 2016 年[调整后的优势比（95%CI）=0.35（0.13-0.96）]定义，决策辅助工具的实施与潜在不适当的 ICU 收治减少相关。
实施 ICU 分诊决策辅助工具与潜在不适当的 ICU 收治减少相关。
