Thomson et al reported a model for predicting readmission to the intensive care unit (ICU) after cardiac surgery. The authors are from St. George's Hospital in London.
Patient selection: cardiac surgery
Parameters:
(1) surgical acuity
(2) diabetes
(3) chronic kidney disease (CKD) stage 3 to 5
(4) hypertension
(5) EuroSCORE (logistic)
(6) ICNARC (Intensive Care National Audit and Research Center) score
(7) preoperative history of neurological disease
(8) aortic valve surgery
(9) postoperative anemia
|
Parameter |
Finding |
Points |
|
surgical acuity |
elective |
0 |
|
|
urgent (and presumably emergent) |
1 |
|
diabetes |
no |
0 |
|
|
yes |
1 |
|
CKD stage 3-5 |
no |
0 |
|
|
yes |
2 |
|
hypertension |
no |
0 |
|
|
yes |
2 |
|
EuroSCORE |
see note |
0 |
|
|
see note |
2 |
|
ICNARC score |
see note |
0 |
|
|
see not |
2 |
|
preoperative neurological disease |
no |
0 |
|
|
yes |
2 |
|
aortic valve surgery |
no |
0 |
|
|
yes |
2 |
|
postoperative anemia |
no |
0 |
|
|
yes |
1 |
where:
• The cutoffs for the EuroSCORE and ICNARC were not stated.
• Patients who were readmitted a logistic EuroSCORE of 4.5 to 11.1 with mean 6.6. Patients who were not readmitted had a EuroSCORE from 2.5 to 7.9 with mean 4.5. >= 6 will be used in the implementation.
• Patients who were readmitted had an ICNARC score from 11 to 19 with mean 14. Patients who were not readmitted had scores from 9 to 15 with mean of 12. >= 14 will be used in the implementation.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The higher the score the greater the risk of ICU readmission.
|
Total Score |
Percent Readmission |
|
<= 3 |
0.4% |
|
4 or 5 |
1.9% |
|
6 or 7 |
2.5% |
|
8 or 9 |
5% |
|
10 to 15 |
10% |
Specialty: Critical Care, Surgery, general
