Admission to intensive care can be reliably predicted using only clinical judgment

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Abstract

Introduction Not all patients in need of critical care arrive in clinical distress and some deteriorate after arrival. Identifying these patients early in their clinical course could potentially improve outcome. The present study was performed with the aim of assessing whether nursing and physician staffwere able to identify patients in need of critical care using only clinical judgment and to compare this with the National Early Warning Score (NEWS). Methods This was a prospective cohort study of all adult patients with a first-time admission to a medical admission unit at a 450-bed regional teaching hospital over a 3-month period in 2010. All subspecialties of internal medicine are present as well as a level 2 ICU. Upon first contact with the patient after arrival, nursing staffand physicians were asked to report their estimation of the probability of ICU admission (0 to 100%). Survival status was extracted from the Danish Civil Registry. All administrative details (including transfers to other hospitals, wards and ICUs) were extracted from the National Patient Registry, both ensuring complete follow-up. The discriminatory power (ability to identify patients at increased risk) was estimated using area under the receiveroperating characteristics curve. Calibration (accuracy) was assessed using Hosmer-Lemeshow goodness of fit test. Data will be reported as median (range) or proportions (95% confidence interval). Results A total of 2,769 patients were included, median age 65 (18 to 100) years and 52% female. Thirty-day mortality was 4.5% and 2.2% were admitted to ICU. Median time to ICU admission was 1 (0 to 70) day. Nursing staffassessed 65% and physicians 26% of admissions. NEWS could be calculated for 85%. Nursing staffhad a discriminatory power of 0.865 (0.786 to 0.944) with little variation with experience. Calibration was acceptable, except for the least experienced nurses (
Original languageEnglish
Article numberP542
JournalCritical Care (Online Edition)
Volume19
Issue numberS1
Pages (from-to)S189
Number of pages1
ISSN1364-8535
Publication statusPublished - 2015
Event35th International Symposium on Intensive Care and Emergency Medicine - Brussels, Belgium
Duration: 17. Mar 201520. Mar 2015

Conference

Conference35th International Symposium on Intensive Care and Emergency Medicine
CountryBelgium
CityBrussels
Period17/03/201520/03/2015

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