Risk Factors for Unplanned Transfer to the ICU after ED Admission

MedicalResearch.com Interview with:
Marleen Boerma MD
Department of Emergency Medicine
Elisabeth-Tweesteden Hospital
Tilburg, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED.

This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor.

MedicalResearch.com: What should readers take away from your report?

Response: In patients presenting to the ED, hypercapnia was a predictor for deterioration which requires ICU transfer within 24 hours after ED admission. Additional predicting factors in patients with sepsis or pneumonia were respectively tachypnea and low oxygen saturation. For these patient groups direct ICU admission should be considered to prevent unplanned ICU admission. This data emphasizes the importance of measuring the vital signs, particularly the respiratory rate.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Due to the retrospective nature of this study, one limitation was a high level of missing data. Besides the already mentioned missing and wrongly recorded respiratory rate the pH, PaCO2 and lactate were missing as well. An arterial blood gas was only performed if indicated probably due to the invasive nature, cost and pain. This limits its value in predicting unplanned ICU transfer and therefore future studies might consider using ETCO2 instead of pCO2 on every potential ICU patient, since this is a noninvasive alternative.

Further, this was a single-center study, with a limited sample size. A multicenter large-scale validation study would strengthen the statistical analysis and increase the generalizability of our results.

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Risk factors for unplanned transfer to the intensive care unit after emergency department admission

Boerma, Lena M. et al.
March 12, 2017
The American Journal of Emergency Medicine , Volume 0 , Issue 0

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Last Updated on March 19, 2017 by Marie Benz MD FAAD