Salt Lake City-based University of Utah School of Medicine researchers developed a risk prediction tool that can indicate which patients are likely to be readmitted to the surgical intensive care unit within days of leaving, according to research presented at the 2016 Clinical Congress of the American College of Surgeons from Oct. 16 to Oct. 20 in Washington, D.C.
The tool, called a nomogram, uses a scoring system that determines patient risk for being readmitted to the surgical ICU. For the study, researchers evaluated the medical records for 3,109 surgical ICU admissions at the University of Utah Hospital between April 2010 and July 2015. They found that 141 patients were readmitted to the surgical ICU within 72 hours of discharge.
Forty-three percent of the patients had undergone trauma procedures, 34 percent had undergone general surgical procedures, 14 percent had vascular operations and 9 percent underwent transplant operations.
Overall, researchers identified 179 possible risk factors that contribute to surgical ICU readmission. They used statistical methods and found seven common risk factors:
• Patient age
• Respiratory rate
• History of atrial fibrillation
• History of renal insufficiency
• Level in the blood of urea nitrogen
• Blood glucose level
• Level of serum chloride
The researchers assigned points to each risk factor based on how much each contributed to risk. For example, with regard to patient age, researchers assigned the following points to different age groups:
• Up to 30 years: 0 to 8 points
• 31 to 60 years: 9 to 15 points
• 61 to 100 years: 16 to 27 points
The points correlate to a percentage indicating readmission risk. A total of 40 points to 79 points, for instance, represents a 1 to 5 percent risk for surgical ICU readmission, notes the study.
"If we can recognize that a patient's condition is at risk of deteriorating before it happens, we may be able to prevent it," Luke A. Martin, MD, a general surgery research resident and the study's presenting author. "And preventing ICU readmission avoids transitions to and from the SICU and the general inpatient ward. Transitions of care are episodes when errors and adverse events often can occur."