van Diepen et al developed a model for predicting readmission to the ICU following cardiac surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Alberta Hospital in Canada.
Patient selection: age >= 18 years, discharge from ICU following cardiac surgery
Outcome: readmission to the ICU
Parameters:
(1) age in years
(2) chronic lung disease
(3) left ventricular ejection fraction (FVEF) in percent
(4) type of cardiac surgery
(5) cardiac arrest
(6) pneumonia
(7) pleural effusion
(8) deep sternal wound infection
(9) infection of harvest site from leg for vascular graft
(10) gastrointestinal (GI) bleeding
(11) neurologic complication (stroke, etc)
|
Parameter |
Finding |
Points |
|
age in years |
< 70 years |
0 |
|
|
70 to 79 years |
1 |
|
|
80 to 89 years |
2 |
|
|
>= 90 years |
3 |
|
chronic lung disease |
no |
0 |
|
|
yes |
2 |
|
LVEF |
>= 35% |
0 |
|
|
20 to 34% |
2.5 |
|
|
< 20% |
5.5 |
|
type of cardiac surgery |
single valve repair/replacement AND CABG |
2 |
|
|
>= 2 valve repair/replacement |
3.5 |
|
|
other |
0 |
|
cardiac arrest |
no |
0 |
|
|
yes |
7 |
|
pneumonia |
no |
0 |
|
|
yes |
5.5 |
|
pleural effusion |
no |
0 |
|
|
yes |
5 |
|
deep sternal wound infection |
no |
0 |
|
|
yes |
9.5 |
|
infection at harvest site leg |
no |
0 |
|
|
yes |
2 |
|
gastrointestinal bleeding |
no |
0 |
|
|
yes |
7.5 |
|
neurologic complications |
no |
0 |
|
|
yes |
4 |
score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 54.5
• The higher the score the greater the risk for readmission.
• For a score > 40 the risk is close to 100%.
• For a score <= 40:
X =
= (0.1952 * (score)) - 3.763
probability of readmission =
= 1 / (1 + EXP((-1) * X)))
Purpose: To identify a patient being discharged from the ICU following cardiac surgery who is likely to be readmitted based on the model of van Diepen et al.
Specialty: Critical Care, Emergency Medicine
Objective: risk factors, severity, prognosis, stage
ICD-10: I97,
