Simplified Score of Chen et al for Transferring a Patient Who Requires Mechanical Ventilation to a Long-Term Care Hospital

Description

Chen et al developed a score for evaluating a patient who requires mechanical ventilation prior to transfer to a long-term care hospital. This can help to identify someone who will require long-term care and to facilitate discharge planning from the intensive care unit (ICU). The authors are from the University of Wisconsin in Madison.

Patient selection: Medicare-eligible patient >= 65 years on mechanical ventilation in ICU

Long-term hospital: provide post-acute care for hospital stays >= 25 days

Time of assessment: day 7 of ICU stay

Parameters:

(1) age

(2) type of admission

(3) region in the United States

(4) hospital location

(5) hospital bed size

(6) coagulopathy

(7) congestive heart failure

(8) renal failure

(9) weight loss

(10) debridement

(11) nutrition

(12) enterostomy

(13) other surgical procedures on the gastrointestinal tract

(14) entry through pleura

(15) other nonsurgical therapeutic procedures on the respiratory system

(16) physical therapy and rehabilitation

(17) tracheostomy and/or gastrostomy

Parameter	Finding	Points
age	< 85 years	0
	>= 85 years	-5
type of admission	elective	10
	non-elective	0
region of the United States	Northeast	5
	other	0
hospital location	urban	5
	other	0
hospital bed size	small	10
	moderate or large	0
coagulolopathy	absent	0
	present	5
congestive heart failure	absent	0
	present	5
renal failure	absent	0
	present	5
weight loss	absent	0
	present	10
debridement of wound, infection or burn	absent	0
	present	20
nutrition	enteral or parenteral	5
	other	0
ileostomy or other enterostomy	absent	0
	present	10
other gastrointestinal surgical procedure	no	0
	yes	10
pleural incision, chest drainage, thoracentesis	absent	0
	present	5
nonsurgical therapeutic procedure on respiratory system	no	0
	yes	5
other physical therapy and rehabilitation needs	no	0
	yes	15
tracheostomy and/or gastrostomy	neither	0
	tracheostomy	35
	gastrostomy	20
	both	30

where:

• Scoring for the combined tracheostomy and gastrostomy involves Table 2. Odds ratio for tracheostomy is 4.7, for gastrostomy is 3.2, both 0.28.

• Patients are less likely to have a long-term stay due to in-hospital mortality.

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: -5

• maximum score: 110

• The higher the score the more likely that the patient will require a long-term hospital stay. The end-point is likelihood of requiring a total hospital stay >= 32 days (7 in ICU plus >= 25 in long-term care hospital).

Score	Risk of Long-Term Stay
< 30	low
30 to 60	intermediate
> 60	high

To read more or access our algorithms and calculators, please log in or register.

Description

Specialty

ICD-10