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clinmed/2000060005v1 (July 27, 2000)
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Triaging ICU discharges to reduce mortality from inappropriate early discharges
Kathleen Daly, Richard Beale, and René W S Chang
Objectives: The aim of this study was to develop a predictive model to triage ICU discharges to reduce post ICU discharge deaths.
Design: Logistic regression analyses and modelling of data of patients who were discharged alive from intensive care units.
Setting: 20 United Kingdom ICUs between 1989 to 1998.
Participants: 3 data sets of ICU survivors – Guy’s Development (5,475 patients ); Guy’s Validation (1,136); and the Riyadh ICU Program Users Group (RIPUG) Validation (7,313) from 19 other ICUs.
Main outcome measures: Post ICU discharge mortality and power of triage model.
Findings: Patients had a post-ICU discharge mortality of up to 12.4%.
The triage model identified patients at risk from death on the ward with a sensitivity and specificity of 65.5% and 87.6%, respectively and an area under the ROC curve of 0.86. Among patients who stayed in the ICU for more than 3 days, post ICU discharge mortality was reduced by 39% for patients at risk if they remained in the ICU for another 48 hours compared to those who were discharged on the same day. There were 2,875 at risk among the patients in the Validation data sets with a post discharge mortality of 25%. An additional 5,750 (16%) ICU bed days would be required if these patients were to remain another 48 hours in the ICU to reduce their post-discharge mortality.
Conclusions: An intensive care discharge triage model has been developed that may reduce post ICU discharge mortality by up to 39%. However, implementing such an approach will require a major increase in the provision of fully staffed ICU beds in the United Kingdom.