A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score

Fernandez Rafael, Baigorri Francisco, Navarro Gema, Artigas, Artigas Antonio

Description

Mortality in the ward after an intensive care unit (ICU) stay is considered a quality parameter, and is described as a source of avoidable mortality. Additionally, the attending intensivist frequently anticipates fatal outcome after ICU discharge. Our objective was to test the ability of a new score to stratify patients according to ward mortality after ICU discharge. Methods A prospective cohort study was performed in the general ICU of a university-affiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome. Results We studied 1,521 patients with a mean age of 60.2 ± 17.8 years. The median (25–75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. Post-ICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84–0.93) for the Sabadell score. Conclusion The Sabadell score at ICU discharge works effectively to stratify patients according to hospital outcome.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2006
• Nombre de lectures: 3
• Langue: English

Extrait

Available onlinehttp://ccforum.com/content/10/6/R179

Vol 10 No 6 Open Access Research A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score 1 12 1 Rafael Fernandez, Francisco Baigorri, Gema Navarroand Antonio Artigas

1 Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n. 08208, Sabadell, Spain 2 Department of Epidemiology, Hospital de Sabadell, Sabadell, Spain Corresponding author: Rafael Fernandez, [e-mail] Received: 28 Jul 2006Revisions requested: 23 Aug 2006Revisions received: 15 Nov 2006Accepted: 27 Dec 2006Published: 27 Dec 2006 Critical Care2006,10:R179 (doi:10.1186/cc5136) This article is online at: http://ccforum.com/content/10/6/R179 © 2006 Fernandezet al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Introductionin the ward after an intensive care unit Mortality (ICU) stay is considered a quality parameter, and is described as a source of avoidable mortality. Additionally, the attending intensivist frequently anticipates fatal outcome after ICU discharge. Our objective was to test the ability of a new score to stratify patients according to ward mortality after ICU discharge.

Methods Aprospective cohort study was performed in the general ICU of a universityaffiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome.

Introduction Mortality in the ward after intensive care unit (ICU) discharge is considered a quality parameter, and is commonly defined as a source of unexpected or avoidable mortality. Mortality has been reported to range from 6% to 27% [1] and can be related to factors occurring before or after the ICU stay. A worse outcome is associated with the physiological reserve before ICU admission [2], the type of illness, the intensity of care required, and the clinical stability and/or the grade of nursing dependence at discharge [3,4]. These data suggest that keeping atrisk patients in the ICU for a further 48 hours might reduce mortality after ICU discharge by 39% [5]. Accordingly, stepdown units may reduce postICU mortality by avoiding inappropriate early discharges from the ICU [6]. It is also yet to be determined whether outreach teams have a favourable impact on the ward mortality rate in this specific population [7].

ResultsWe studied 1,521 patients with a mean age of 60.2 ± 17.8 years. The median (25–75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. PostICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84–0.93) for the Sabadell score.

ConclusionSabadell score at ICU discharge works The effectively to stratify patients according to hospital outcome.

Nevertheless, fatal outcome in the ward after ICU discharge is frequently an anticipated event [8]. A significant number of patients survive the critical illness with sequelae that severely limit the quality of life and with expectations for a full functional recovery. The only tools presently available to predict hospital mortality are the standard severity scores at ICU admission [9], and calibration of these scores after ICU discharge is poor. Our hypothesis was that ward mortality can be more accurately anticipated by the attending intensivists at ICU dis charge, as suggested in our preliminary report [10]. The objec tive of the present study was to analyse postICU mortality and the predictive power of a new subjective score at ICU dis charge to stratify patients and their hospital outcome.

Materials and methods Our Critical Care Department comprises a closed 16bed medicalsurgical ICU and a closed 10bed stepdown unit. The 10 ICU physicians attend in working hours, and are also

APACHE = Acute Physiologic and Chronic Health Evaluation; ICU = intensive care unit.

Page 1 of 6 (page number not for citation purposes)