INTENSIV-News
Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model.
Daly K, Beale R, Chang RWS BMJ 2001; 322:1274-6
St Thomas´s Hospital, London SE1 7EH.
OBJECTIVE:
To develop a predictive model to triage patients for discharge from
intensive care units to reduce mortality after discharge.
DESIGN: Logistic regression analyses and modelling of data from patients who were discharged from intensive care units.
SETTING: Guy´s hospital intensive care unit and 19 other UK intensive care units from 1989 to 1998.
PARTICIPANTS: 5475 patients for the development of the model and 8449 for validation.
MAIN OUTCOME MEASURE: Mortality after discharge and power of triage model.
RESULTS:
Mortality after discharge from intensive care was up to 12.4%. The
triage model identified patients at risk from death on the ward with a
sensitivity of 65.5% and specificity of 87.6%, and an area under the
receiver operating curve of 0.86. Variables in the model were age, end
stage disease, length of stay in unit, cardiothoracic surgery, and
physiology. In the validation dataset the 34% of the patients identified
as at risk had a discharge mortality of 25% compared with a 4%
mortality among those not at risk.
CONCLUSIONS: The discharge
mortality of at risk patients may be reduced by 39% if they remain in
intensive care units for another 48 hours. The discharge triage model to
identify patients at risk from too early and inappropriate discharge
from intensive care may help doctors to make the difficult clinical
decision of whom to discharge to make room for a patient requiring
urgent admission to the unit. If confirmed, this study has implications
on the provision of resources.
Die Motivation für die vorliegende Arbeit entstand aus der Knappheit an Intensivbetten und ihren Konsequenzen. Aus der Sicht der Autoren ist eine Folge die inadäquate, vorzeitige Verlegung der Intensivpatienten auf Normalbettenstationen und die inakzeptabel hohe Spitalsmortalität (9% bis 27%).
Melden Sie sich an um weiter zu lesen ...
Tags: intensiv-news qualitätssicherung bettenbelegung normalstation
Wir wollen Fachärzte und Pfleger topaktuell und wissenschaftlich fundiert über Studien, fachspezifische Entwicklungen und deren praktische Umsetzung informieren, um sie in ihrer Arbeit und Fortbildung zu unterstützen.
Wählen Sie dazu bitte Ihr Land aus.