Jayshil J Patel1, Jonathan Kurman2, Easa Al-Ghandour3, Krishna Thandra4, Samih Mawari5, Jeanette Graf6, Jennifer Kovac7, Lisa Rein8, Steven Q Simpson9. 1. Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. 2. Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA. 3. War Memorial Hospital, Sault Ste. Marie, MI, USA. 4. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. John Dingell Veteran's Affairs Medical Center, Detroit, MI, USA. 6. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, WI, USA. 7. Department of Emergency Medicine, Medical College of Wisconsin, WI, USA. 8. Institute for Health and Society, Medical College of Wisconsin, WI, USA. 9. Division of Pulmonary and Critical Care Medicine, University of Kansas, Kansas City, KS, USA.
Abstract
PURPOSE: To identify variables associated with 24-h mortality after inter-hospital transfer. MATERIALS AND METHODS: Single center retrospective study of adult patients transferred to a tertiary care medical ICU between 1 January 2010 and 15 April 2014. Demographic, clinical, physiologic, and laboratory data were collected. The Lasso method was used for logistic regression to identify predictors of 24-h mortality after inter-hospital ICU transfer. RESULTS: We identified 773 patients. Median age was 58 years (IQR 45-69), 49% were female, 83% Caucasian, and 48% had Medicare. The median length of stay at the transferring facility was 1.0 day (IQR 0-2). Median SOFA score on the day of ICU transfer was 5 (IQR 2-8). Twenty-two (3%) died within 24 h after inter-hospital transfer. SOFA score of 12-16 the day of inter-hospital transfer (odds ratio (OR) 7.77, 95% CI 1.21-66.26, p = 0.037), FiO2 0.8-1.0 on ICU arrival, and cardiac arrest prior to transfer (OR 4.94, 95% CI 1.43-15.96, p = 0.009) were associated with an increased risk for 24-h mortality after inter-hospital transfer. CONCLUSIONS: Our study identified biologically plausible and potentially modifiable factors associated with 24-h mortality after inter-hospital medical ICU transfer, which may serve to inform patients and families of readiness and risk for mortality after inter-hospital transfer.
PURPOSE: To identify variables associated with 24-h mortality after inter-hospital transfer. MATERIALS AND METHODS: Single center retrospective study of adult patients transferred to a tertiary care medical ICU between 1 January 2010 and 15 April 2014. Demographic, clinical, physiologic, and laboratory data were collected. The Lasso method was used for logistic regression to identify predictors of 24-h mortality after inter-hospital ICU transfer. RESULTS: We identified 773 patients. Median age was 58 years (IQR 45-69), 49% were female, 83% Caucasian, and 48% had Medicare. The median length of stay at the transferring facility was 1.0 day (IQR 0-2). Median SOFA score on the day of ICU transfer was 5 (IQR 2-8). Twenty-two (3%) died within 24 h after inter-hospital transfer. SOFA score of 12-16 the day of inter-hospital transfer (odds ratio (OR) 7.77, 95% CI 1.21-66.26, p = 0.037), FiO2 0.8-1.0 on ICU arrival, and cardiac arrest prior to transfer (OR 4.94, 95% CI 1.43-15.96, p = 0.009) were associated with an increased risk for 24-h mortality after inter-hospital transfer. CONCLUSIONS: Our study identified biologically plausible and potentially modifiable factors associated with 24-h mortality after inter-hospital medical ICU transfer, which may serve to inform patients and families of readiness and risk for mortality after inter-hospital transfer.
Entities:
Keywords:
Critical care; inter-hospital transfer; medical intensive care unit; organ dysfunction; outcomes
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