Wardi et al reported predictors that can help to identify a patient admitted from the Emergency Department with severe sepsis who may have an unexpected transfer to the intensive care unit (ICU). These can help to identify a patient who may benefit from more aggressive management. The authors are from University of California San Diego Health System.
Patient selection: severe sepsis, admitted from the Emergency Department (ED)
Outcome: unexpected transfer to the ICU within 48 hours of admission
A patient who undergoes unexpected transfer will have appeared to have responded well to initial therapy but decompensates later.
Predictors of unexpected transfer to the ICU:
(1) initial serum lactate >= 4 mmol/L
(2) admission during the night
Indicators for ICU admission:
(1) hemodynamic instability and/or shock
(2) need for vasoactive drugs or invasive blood pressure monitoring
(3) need for mechanical ventilation
(4) profound mental status change
(5) need for high level of nursing requirements only available in the ICU
Mortality was:
(1) worse for a patient transferred to the ICU (25% if transferred, 8% if not)
(2) comparable for direct admission to the ICU and unexpected transfers (25%)
