澳大利亚和新西兰的快速反应团队审查后，非计划性 ICU 入院来自医院病房。

Unplanned ICU Admission From Hospital Wards After Rapid Response Team Review in Australia and New Zealand.

机构信息

Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Prahran, Melbourne VIC, Australia.

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia.

出版信息

Crit Care Med. 2020 Jul;48(7):e550-e556. doi: 10.1097/CCM.0000000000004353.

DOI:10.1097/CCM.0000000000004353

PMID:32304417

Abstract

OBJECTIVES

To evaluate what proportion of unplanned ICU admissions from hospital wards occurred after rapid response team review and compare baseline characteristics and outcomes of patients admitted after rapid response team review with non-rapid response team-related admissions.

DESIGN

Multicenter binational retrospective cohort study.

SETTING

One-hundred seventy-eight ICUs across Australia and New Zealand.

PATIENTS

All adults (≥ 17 yr) in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2017.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Among 97,181 unplanned ICU admissions from the ward, prior rapid response team review occurred in 55,084 cases (56.7%). Rapid response team patients were slightly older (65.4 [16.9] vs 63.3 [18]), had a higher Acute Physiology and Chronic Health Evaluation III score (64.6 [27.1] vs 54.7 [25.3]) and more frequently had limitations of medical treatment (13.1% vs 8.5%) compared with patients with no rapid response team review. The strongest independent associations with ICU admission following rapid response team review included age, ICU admission diagnosis (especially sepsis-, neurologic-, respiratory-, and cardiovascular-related), tertiary ICU status, and presence of limitations of medical treatment (p < 0.0001 all comparisons). Rapid response team-related ICU admissions had a longer median ICU (2.4 d [1.2-4.6 d] vs 2.1 d [1.0-4.2 d]) and hospital (12.8 d [7.0-23.6 d] vs 10.8 d [5.9-20.3 d]) length of stay, and were more likely to die in the ICU (12.3% vs 7.5%) and in-hospital (20.8% vs 13.5%) (p < 0.0001). After adjusting for illness severity and institution, patients admitted following rapid response team review stayed longer in hospital but were not at increased risk of dying in-hospital (adjusted odds ratio, 1.03; 0.98-1.07).

CONCLUSIONS

In Australia and New Zealand, hospital ward patients admitted to ICU following rapid response team review represent the majority of ward-based ICU admissions, are more chronically and acutely ill, and more frequently have sepsis than those admitted from the ward without rapid response team review. Their unadjusted outcomes are worse, but after adjustment their mortality is similar.

摘要

目的

评估有多少例非计划性 ICU 入院是在快速反应团队（RRT）审查后发生的，并比较 RRT 审查后与非 RRT 相关的入院患者的基线特征和结局。

设计

多中心、两国回顾性队列研究。

地点

澳大利亚和新西兰的 178 个 ICU。

患者

2012 年至 2017 年期间，澳大利亚和新西兰重症监护学会成人患者数据库中所有年龄≥17 岁的成年人（≥17 岁）。

干预措施

无。

测量和主要结果

在 97181 例从病房转入的非计划性 ICU 中，有 55084 例（56.7%）在 RRT 审查前发生。RRT 组患者年龄稍大（65.4[16.9]岁 vs. 63.3[18]岁），急性生理学和慢性健康评估评分更高（64.6[27.1]分 vs. 54.7[25.3]分），且更常存在治疗限制（13.1% vs. 8.5%）。与未接受 RRT 审查的患者相比，RRT 审查后 ICU 入住的最强独立关联因素包括年龄、ICU 入院诊断（尤其是脓毒症、神经、呼吸和心血管相关诊断）、三级 ICU 状态和存在治疗限制（所有比较均 p<0.0001）。RRT 相关 ICU 入院的 ICU（2.4 d[1.2-4.6 d] vs. 2.1 d[1.0-4.2 d]）和医院（12.8 d[7.0-23.6 d] vs. 10.8 d[5.9-20.3 d]）住院时间更长，且 ICU（12.3% vs. 7.5%）和院内（20.8% vs. 13.5%）死亡率更高（均 p<0.0001）。在校正疾病严重程度和机构后，RRT 审查后入院的患者在医院的住院时间更长，但院内死亡率无升高（校正比值比，1.03；98%-1.07）。