readmissions and death after icu discharge development and validation of two predictive modelsicu出院后发生率和死亡两个预测模型的发展和验证.pdfVIP

Readmissions and Death after ICU Discharge: Development and Validation of Two Predictive Models Omar Badawi1,2*, Michael J. Breslow1 1 Research Product Innovation, Philips Healthcare, Baltimore, Maryland, United States, 2 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, United States Abstract Introduction: Early discharge from the ICU is desirable because it shortens time in the ICU and reduces care costs, but can also increase the likelihood of ICU readmission and post-discharge unanticipated death if patients are discharged before they are stable. We postulated that, using eICUH Research Institute (eRI) data from .400 ICUs, we could develop robust models predictive of post-discharge death and readmission that may be incorporated into future clinical information systems (CIS) to assist ICU discharge planning. Methods: Retrospective, multi-center, exploratory cohort study of ICU survivors within the eRI database between 1/1/2007 and 3/31/2011. Exclusion criteria: DNR or care limitations at ICU discharge and discharge to location external to hospital. Patients were randomized (2:1) to development and validation cohorts. Multivariable logistic regression was performed on a broad range of variables including: patient demographics, ICU admission diagnosis, admission severity of illness, laboratory values and physiologic variables present during the last 24 hours of the ICU stay. Multiple imputation was used to address missing data. The primary outcomes were the area under the receiver operator characteristic curves (auROC) in the validation cohorts for the models predicting readmission and death within 48 hours of ICU discharge. Results: 469,976 and 234,987 patients representing 219 hospitals were in the development and validation cohorts. Early ICU readmission and death was