Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA.
The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Crit Care Med. 2019 Oct;47(10):e814-e819. doi: 10.1097/CCM.0000000000003906.
Discharge destination is a commonly used surrogate for long-term recovery in rehabilitation studies. We determined the accuracy of discharge destination as a surrogate marker for 6-month mobility impairment in acute respiratory distress syndrome survivors.
DESIGN/SETTING: Secondary analysis of the Economic Analysis of Pulmonary Artery Catheters study, a long-term observational sub-study of the National Institutes of Health/National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial.
Patients underwent functional assessment using the Health Utilities Index-2 mobility domains at 6 months. A score greater than or equal to 3 (i.e., need for assistive device) defined mobility impairment. Discharge to any institutional care constituted a care facility discharge. We used logistic regression to explore the association between discharge destination and mobility impairment. We generated test characteristics and receiver operating characteristics to assess the accuracy of discharge destination as a surrogate for mobility impairment.
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A total of 591 patients were enrolled in Economic Analysis of Pulmonary Artery Catheters in whom 328 had functional measurements at 6 months with 116 (35%) of these patients discharged to a care facility. Care facility patients were older (mean age 53 vs 44 yr; p < 0.001) and had longer hospital durations (length of stay 29 vs 17 d; p < 0.001). Care facility discharge was associated with greater 6-month mobility impairment. Sensitivity and specificity of discharge to a care facility for mobility impairment were 40.5% (95% CI, 32.0-49.6%) and 79.3% (95% CI, 73.3-84.2%) at 6 months. Discharge destination alone was a poor discriminator of long-term mobility impairment (receiver operating characteristic area under the curve: 0.61 at 6 mo).
Discharge to a care facility was strongly associated with mobility impairment 6 months after acute respiratory distress syndrome but discharge destination alone performed poorly as a surrogate for mobility impairment.
出院去向是康复研究中常用的长期康复替代指标。我们确定了急性呼吸窘迫综合征幸存者出院去向作为 6 个月运动障碍的替代标志物的准确性。
设计/设置：国家卫生研究院/国家心肺血液研究所急性呼吸窘迫综合征网络液体和导管治疗试验的长期观察性子研究经济分析肺动脉导管研究的二次分析。
患者在 6 个月时使用健康效用指数-2 移动域进行功能评估。评分大于或等于 3（即需要辅助设备）定义为运动障碍。任何机构护理的出院构成了护理设施的出院。我们使用逻辑回归来探讨出院去向与运动障碍之间的关系。我们生成了测试特征和接收者操作特征，以评估出院去向作为运动障碍替代指标的准确性。
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经济分析肺动脉导管研究共纳入 591 例患者，其中 328 例在 6 个月时进行了功能测量，其中 116 例（35%）患者出院至护理机构。护理机构患者年龄较大（平均年龄 53 岁比 44 岁；p <0.001），住院时间较长（住院时间 29 天比 17 天；p <0.001）。护理机构出院与 6 个月时更大的运动障碍相关。护理机构出院与运动障碍的敏感性和特异性分别为 40.5%（95%CI，32.0-49.6%）和 79.3%（95%CI，73.3-84.2%）。6 个月时，出院单独作为长期运动障碍的判别器较差（接受者操作特征曲线下面积：0.61）。
急性呼吸窘迫综合征后 6 个月，出院至护理机构与运动障碍密切相关，但出院单独作为运动障碍的替代指标表现不佳。
