Photo Credit: Andrii Yalanskyi

The following is a summary of “Beyond Unplanned ICU Transfers: Linking a Revised Definition of Deterioration to Patient Outcomes,” published in the June 2024 issue of Critical Care by Byrd et al.

Researchers conducted a retrospective study to create a novel, electronic tool that accurately predicts short-term mortality and identifies clinical deterioration in hospitalized controls earlier than currently used standardized definitions.

They employed a mixed-methods approach, combining exploratory record review with quantitative analysis and regression techniques. The data was collected from a 12-hospital community-academic health system encompassing all adult patients admitted for acute care (January 2018 and December 2022).

The result showed a revised electronic definition of deterioration based on specific clinical triggers like respiratory failure, bleeding, and hypotension occurring near ICU transfers. Patients identified by this new definition were significantly more likely to experience adverse outcomes. A 12.5 times higher risk of death was faced within 7 days (aOR 12.5; 95% CI, 8.9–17.4) and a 95.3% increase in length of stay (95% CI, 88.6–102.3%) compared to those transferred to ICU or deceased regardless of meeting the definition. Critically, the new definition in 1,812 patients identified deterioration up to 6 hours earlier (median-57 minutes) in over half (52.4%) of patients destined for ICU transfer (IQR 64.0–363.5 min). Early detection presents a valuable opportunity for early intervention, potentially improving patient outcomes.

Investigators concluded that a novel electronic deterioration definition predicts short-term mortality and identifies decline over 2.5 hours before ICU transfer. Integrating the definition into early warning systems promises earlier intervention and improved patient outcomes.

Source: journals.lww.com/ccmjournal/abstract/9900/beyond_unplanned_icu_transfers__linking_a_revised.339.aspx