Journal of Korean Biological Nursing Science

Korean society of Biological Nursing Science (한국기초간호학회)
권호 표지
DOI QR코드

DOI QR Code

Analysis of Risk Factors to Predict Intensive Care Unit Transfer in Medical in-Patients

내과 환자의 중환자실 전동에 대한 위험요인 분석

  • Received : 2014.07.18
  • Accepted : 2014.10.04
  • Published : 2014.11.28
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to analyze risk factors in predicting medical patients transferred to Intensive Care Unit (ICU) on the general ward. Methods: We reviewed retrospectively clinical data of 120 medical patients on the general ward and a Modified Early Warning Score (MEWS) between ICU group and general ward group. Data were analyzed with multivariate logistic regression and the area under the receiver operating characteristic curves using SPSS/WIN 18.0 program. Results: Fifty-two ICU patients and 68 general ward patients were included. In multivariate logistic regression, the MEWSs (Odds Ratio [OR], 1.91; 95% confidence interval [CI], 1.32-2.76), sequential organ failure assessment score (OR, 1.28; 95% CI, 1.10-1.72), $PaO_2/FiO_2$ ratio (OR, 0.98; 95% CI, 0.98-0.99), and saturation (OR, 0.93; 95% CI, 0.88-0.99) were predictive of ICU transfer. The sensitivity and the specificity of the MEWSs used with a cut-off value of six were 80.8% and 70.6% respectively for ICU transfer. Conclusion: These findings suggest that early prediction and treatment of patients with high risk of ICU transfer may improve the prognosis of patients.

Keywords

References

  1. Bellomo, R., Goldsmith, D., Uchino, S., Buckmaster, J., Hart, G., Opdam, H., et al. (2004). Prospective controlled trial of effect of medical emergency team on post-operative morbidity and mortality rates. Critical Care Medicine, 32(4), 916-921.http://dx.doi.org/10.1097/01.CCM.0000119428.02968.9E
  2. Buist, M. D., Moore, G. E., Bernard, S. A., Waxman, B. P., Anderson, J. N., & Nguyen, T. V. (2002). Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. British Medical Journal, 324(7334), 387-390. http://dx.doi.org/10.1136/bmj.324.7334.387
  3. Byeon, Y. S., Choe, M. A., Kim, H. S., Park, M. J., Seo, W. S., Lee, K. S., et al. (2002). A study of content analysis on ICU (Intensive Care Unit) Nurses' Knowledge of Basic Nursing Sciences. Journal of Korean Biological Nursing Science, 4(1), 41-49.
  4. Choe, M. A., An, G. J., & Jeong, J. S. (2012). A coorientation analysis of perception on bionursing between clinical nurses and nursing professors. Journal of Korean Biological Nursing Science, 14(3), 212-220. http://dx.doi.org/10.7586/jkbns.2012.14.3.212
  5. Cooksley, T., Kitlowski, E., & Haji-Michael, P. (2012). Effectiveness of modified early warning score in predicting outcomes in oncology patients. QJM, 105(11), 1083-1088. http://dx.doi.org/10.1093/qjmed/hcs138
  6. Cuthbertson, B. H., Boroujerdi, M., McKie, L., Aucott, L., & Prescott, G. (2007). Can physiological variables and early warning scoring systems allow early recognition of the deteriorating surgical patient? Critical Care Medicine, 35(2), 402-409. http://dx.doi.org/10.1097/01.CCM.0000254826.10520.87
  7. DeVita, M. A., Braithwaite, R. S., Mahidhara, R., Stuart, S., Foraida, M., & Simmons, R. L. (2004). Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Quality and Safety in Health Care, 13(4), 251-254. http://dx.doi.org/10.1136/qshc.2003.006585
  8. DeVita, M. A., Bellomo, R., Hillman, K., Kellum, J., Rotondi, A., Teres, D., et al. (2006). Findings of the first consensus conference on medical emergency teams. Critical Care Medicine, 34(9), 2463-2478. http://dx.doi.org/10.1097/01.CCM.0000235743.38172.6E
  9. Ferreira, F. L., Bota, D. P., Bross, A., Melot, C., & Vincent, J. L. (2001). Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA, 286(14), 1754-1758. http://dx.doi.org/10.1001/jama.286.14.1754
  10. Gardner-Thorpe, J., Love, N., Wrightson, J., Walsh, S., & Keeling, N. (2006). The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Annals of the Royal College of Surgeons of England, 88(6), 571-575. http://dx.doi.org/10.1308/003588406x130615
  11. Goldhill, D. R., Worthington, L., Mulcahy, A., Tarling, M., & Sumner, A. (1999). The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia, 54(9), 853-860. http://dx.doi.org/10.1046/j.1365-2044.1999.00996.x
  12. Harrison, G. A., Jacques, T. C., Kilborn, G., & McLaws, M. L. (2005). The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards-the SOCCER study. Resuscitation, 65(2), 149-157. http://dx.doi.org/10.1016/j.resuscitation.2004.11.017
  13. Heron, M. (2013). Deaths: leading causes for 2010. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, 62(6), 1-97.
  14. Hillman, K. M., Bristow, P. J., Chey, T., Daffurn, K., Jacques, T., Norman, S. L., et al. (2002). Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Medicine, 28(11), 1629-1634. http://dx.doi.org/10.1007/s00134-002-1496-y
  15. Kause, J., Smith, G., Prytherch, D., Parr, M., Flabouris, A., & Hillman, K. (2004). A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom-the ACADEMIA study. Resuscitation, 62(3), 275-282. http://dx.doi.org/10.1016/j.resuscitation.2004.05.016
  16. Korea National Statistical Office. (2012). Annual report on the cause of death statistics. International Statistics Yearbook, Seoul, Korea.
  17. Lee, A., Bishop, G., Hillman, K. M., & Daffurn, K. (1995). The medical emergency team. Anaesthesia and Intensive Care, 23(2), 183-186.
  18. Lee, J. R., & Choi, H. R. (2014). Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards. Journal of Korean Academy of Nursing, 44(2), 219-227. http://dx.doi.org/10.4040/jkan.2014.44.2.219
  19. McQuillan, P., Pilkington, S., Allan, A., Taylor, B., Short, A., Morgan, G., et al. (1998). Confidential inquiry into quality of care before admission to intensive care. British Medical Journal, 316(7148), 1853-1858. http://dx.doi.org/10.1136/bmj.316.7148.1853
  20. Mulligan, A. (2010). Validation of a physiological track and trigger score to identify developing critical illness in hematology patients. Intensive and Critical Care Nursing, 26(4), 196-206. http://dx.doi.org/10.1016/j.iccn.2010.03.002
  21. Odell, M., Victor, C., & Oliver, D. (2009). Nurses' role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing, 65(10), 1992-2006. http://dx.doi.org/10.1111/j.1365-2648.2009.05109.x
  22. Park, T., Hong, S. B., Lim, C. M., & Koh, Y. (2010). Effect of admission time to the medical intensive care unit on acute critical patient outcomes. Korean Journal of Critical Care Medicine, 25(2), 71-75. http://dx.doi.org/10.4266/kjccm.2010.25.2.71
  23. Subbe, C. P., Kruger, M., Rutherford, P., & Gemmel, L. (2001). Validation of a modified early warning score in medical admissions. QJM, 94(10), 521-526. http://dx.doi.org/10.1093/qjmed/94.10.521
  24. Wilson, R. M., Harrison, B. T., Gibberd, R. W., & Hamilton, J. D. (1999). An analysis of the causes of adverse events from the Quality in Australian Health Care Study. The Medical Journal of Australia, 170(9), 411-415.
  25. Vincent, J. L., De Mendonca, A., Cantraine, F., Moreno, R., Takala, J., Suter, P. M., et al (1998). Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Critical Care Medicine, 26(11), 1793-1800. https://doi.org/10.1097/00003246-199811000-00016

Cited by

  1. 병동 급성악화 환자의 중환자실 전동 위험요인 분석 vol.19, pp.4, 2014, https://doi.org/10.14400/jdc.2021.19.4.467