Readmissions and Death after ICU Discharge Development and Validation of Two Predictive Models 英文参考文献.docVIP

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Readmissions and Death after ICU Discharge Development and Validation of Two Predictive Models 英文参考文献.doc

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Readmissions and Death after ICU Discharge Development and Validation of Two Predictive Models 英文参考文献

ReadmissionsandDeathafterICUDischarge: DevelopmentandValidationofTwoPredictiveModels OmarBadawi1,2*,MichaelJ.Breslow1 1ResearchProductInnovation,PhilipsHealthcare,Baltimore,Maryland,UnitedStates,2DepartmentofPharmacyPracticeandScience,UniversityofMarylandSchoolof Pharmacy,Baltimore,Maryland,UnitedStates Abstract Introduction:EarlydischargefromtheICUisdesirablebecauseitshortenstimeintheICUandreducescarecosts,butcan alsoincreasethelikelihoodofICUreadmissionandpost-dischargeunanticipateddeathifpatientsaredischargedbefore theyarestable. Wepostulatedthat,using eICUHResearchInstitute(eRI)datafrom.400ICUs,wecoulddeveloprobust models predictive of post-discharge death and readmission that may be incorporated into future clinical information systems(CIS)toassistICUdischargeplanning. Methods:Retrospective,multi-center,exploratorycohortstudyofICUsurvivorswithintheeRIdatabasebetween1/1/2007 and3/31/2011.Exclusioncriteria:DNRorcarelimitationsatICUdischargeanddischargetolocationexternaltohospital. Patientswererandomized(2:1)todevelopmentandvalidationcohorts.Multivariablelogisticregressionwasperformedona broadrangeofvariablesincluding:patientdemographics,ICUadmissiondiagnosis,admissionseverityofillness,laboratory valuesandphysiologicvariablespresentduringthelast24hoursoftheICUstay.Multipleimputationwasusedtoaddress missing data. The primary outcomes were the area under the receiver operator characteristic curves (auROC) in the validationcohortsforthemodelspredictingreadmissionanddeathwithin48hoursofICUdischarge. Results:469,976and234,987patientsrepresenting219hospitalswereinthedevelopmentandvalidationcohorts.EarlyICU readmission and death was experienced by 2.54% and 0.92% of all patients, respectively. The relationship between predictors and outcomes (death vs readmission) differed, justifying the need for separate models. The models for early readmissionanddeathproducedauROCsof0.71and0.92,respectively.Bothmodelscalibratedwellacrossriskgroups. Conclusions:Ourmodelsfordeathand