Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system
Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system
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DOI：
10.1002/jhm.1979
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发表时间：
2013-01-01
影响因子：
2.6
通讯作者：
Escobar, Gabriel J.
中科院分区：
文献类型：
--
作者：
Delgado, M. Kit;Liu, Vincent;Escobar, Gabriel J.
背景：急诊（ED）病房入院后24小时内转至重症监护病房（ICU）的死亡率高于直接转至ICU的死亡率。设计、环境、患者：描述从急诊科到达病房后24小时内非计划ICU转移的危险因素。方法：评估13家美国社区医院的178,315名急诊科非ICU入院患者。我们根据患者特点和医院容量将计划外ICU转移的结果制成表格。在调整了患者和医院的差异后，我们提出了与非计划ICU转移相关的因素。结果：24小时内转至ICU的非ICU住院患者4252例（2.4%）。入院诊断与意外转移最相关，按患病率降序排列为：肺炎（优势比[OR] 1.5； 95%可信区间[CI] 1.21.9）、心肌梗死（OR）（比值比1.5；95%可信区间[CI] 1.22.0）、慢性阻塞性肺疾病（COPD）（比值比1.4；95%可信区间1.11.9）、败血症（比值比2.5；95%可信区间1.93.3）和灾难性疾病（比值比2.3；95%可信区间1.73.0）。其他重要的预测因素包括：男性，合并症评分bbbb145，实验室急性生理评分=7，在晚上11点到早上7点之间到达病房。入住受监测的过渡护理单位（OR 0.83; 95% CI 0.770.90）和入住规模较大的医院（OR 0.94 / 1000额外的年度急诊科住院患者；95% CI 0.910.98），风险降低。结论：合并呼吸系统疾病、心肌梗死或脓毒症的急诊科患者意外转至ICU的风险适度增加，并可能从急诊科更好的分诊、早期干预或更密切的监测中获益，以防止急性失代偿。需要更多的研究来确定中间护理单位、医院容量、一天中的时间和性别如何影响非计划的ICU转移。医院医学杂志2013。(c) 2012年医院医学会
BACKGROUND: Emergency department (ED) ward admissions subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions. DESIGN, SETTING, PATIENTS: Describe risk factors for unplanned ICU transfer within 24 hours of ward arrival from the ED. METHODS: Evaluation of 178,315 ED non-ICU admissions to 13 US community hospitals. We tabulated the outcome of unplanned ICU transfer by patient characteristics and hospital volume. We present factors associated with unplanned ICU transfer after adjusting for patient and hospital differences in a hierarchical logistic regression. RESULTS: There were 4,252 (2.4%) non-ICU admissions transferred to the ICU within 24 hours. Admitting diagnoses most associated with unplanned transfer, listed by descending prevalence were: pneumonia (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.21.9), myocardial infarction (MI) (OR 1.5; 95% CI 1.22.0), chronic obstructive pulmonary disease (COPD) (OR 1.4; 95% CI 1.11.9), sepsis (OR 2.5; 95% CI 1.93.3), and catastrophic conditions (OR 2.3; 95% CI 1.73.0). Other significant predictors included: male sex, Comorbidity Points Score >145, Laboratory Acute Physiology Score =7, arriving on the ward between 11 PM and 7 AM. Decreased risk was found with admission to monitored transitional care units (OR 0.83; 95% CI 0.770.90) and to higher volume hospitals (OR 0.94 per 1,000 additional annual ED inpatient admissions; 95% CI 0.910.98). CONCLUSIONS: ED patients admitted with respiratory conditions, MI, or sepsis are at modestly increased risk for unplanned ICU transfer and may benefit from better triage from the ED, earlier intervention, or closer monitoring to prevent acute decompensation. More research is needed to determine how intermediate care units, hospital volume, time of day, and sex affect unplanned ICU transfer. Journal of Hospital Medicine 2013. (c) 2012 Society of Hospital Medicine