Predicting death and readmission after intensive care discharge

A. J. Campbell, J. A. Cook, G. Adey, Brian Cuthbertson

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background. Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.

Methods. This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU.

Results. Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.

Conclusions. We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.

Original languageEnglish
Pages (from-to)656-662
Number of pages7
JournalBritish Journal of Anaesthesia
Volume100
Issue number5
Early online date2 Apr 2008
DOIs
Publication statusPublished - May 2008

Keywords

  • complications
  • death
  • morbidity
  • intensive care
  • model
  • statistical
  • outreach team
  • unit
  • mortality
  • multicenter
  • outcomes
  • quality
  • system

Cite this

Campbell, A. J., Cook, J. A., Adey, G., & Cuthbertson, B. (2008). Predicting death and readmission after intensive care discharge. British Journal of Anaesthesia, 100(5), 656-662. https://doi.org/10.1093/bja/aen069

Predicting death and readmission after intensive care discharge. / Campbell, A. J.; Cook, J. A.; Adey, G.; Cuthbertson, Brian.

In: British Journal of Anaesthesia, Vol. 100, No. 5, 05.2008, p. 656-662.

Research output: Contribution to journalArticle

Campbell, AJ, Cook, JA, Adey, G & Cuthbertson, B 2008, 'Predicting death and readmission after intensive care discharge', British Journal of Anaesthesia, vol. 100, no. 5, pp. 656-662. https://doi.org/10.1093/bja/aen069
Campbell, A. J. ; Cook, J. A. ; Adey, G. ; Cuthbertson, Brian. / Predicting death and readmission after intensive care discharge. In: British Journal of Anaesthesia. 2008 ; Vol. 100, No. 5. pp. 656-662.
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abstract = "Background. Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.Methods. This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU.Results. Four hundred and seventy-five patients (11.2{\%}) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8{\%}) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3{\%}) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.Conclusions. We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.",
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AU - Adey, G.

AU - Cuthbertson, Brian

N1 - This is a pre-copy-editing, author-produced PDF of an article accepted for publication in British Journal of Anaesthesia following peer review. The definitive publisher-authenticated version Campbell, AJ., Cook, JA., Adey, G. & Cuthbertson, B. (2008). 'Predicting death and readmission after intensive care discharge.' British Journal of Anaesthesia 100(5) pp. 656-662. is available online at: http://dx.doi.org10.1093/bja/aen069.

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N2 - Background. Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.Methods. This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU.Results. Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.Conclusions. We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.

AB - Background. Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.Methods. This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU.Results. Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.Conclusions. We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.

KW - complications

KW - death

KW - morbidity

KW - intensive care

KW - model

KW - statistical

KW - outreach team

KW - unit

KW - mortality

KW - multicenter

KW - outcomes

KW - quality

KW - system

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DO - 10.1093/bja/aen069

M3 - Article

VL - 100

SP - 656

EP - 662

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 5

ER -