Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma

2014 ◽  
Vol 8 (4) ◽  
pp. 326-332 ◽  
Author(s):  
Ari M. Lipsky ◽  
Yoram Klein ◽  
Adi Givon ◽  
Moti Klein ◽  
Jeffrey S. Hammond ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Trauma Patients ◽  
Likelihood Ratios ◽  
Icu Admission ◽  
Number Of Patients ◽  
Definition Of ◽  
Sensitivity Specificity ◽  
Blast Trauma ◽  
Injured Patients

ABSTRACTObjectiveWe investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.MethodsWe conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.ResultsA total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.ConclusionsTriage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (Disaster Med Public Health Preparedness. 2014;0:1–7)

scholarly journals The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

2020 ◽  
Vol 11 (01) ◽  
pp. 182-189
Author(s):  
Ellen T. Muniga ◽  
Todd A. Walroth ◽  
Natalie C. Washburn
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Number Of Patients ◽  
Order Sets ◽  
Critical Care Admission ◽  
The Impact ◽  
Order Set

Abstract Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

scholarly journals Patient length of stay and mortality prediction: A survey

2017 ◽  
Vol 30 (2) ◽  
pp. 105-120 ◽  
Author(s):  
Aya Awad ◽  
Mohamed Bader–El–Den ◽  
James McNicholas
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Length Of Hospital Stay ◽  
Hospital Performance ◽  
Mortality Prediction ◽  
Cost Of Care ◽  
Resource Utilisation ◽  
Number Of Patients

Over the past few years, there has been increased interest in data mining and machine learning methods to improve hospital performance, in particular hospitals want to improve their intensive care unit statistics by reducing the number of patients dying inside the intensive care unit. Research has focused on prediction of measurable outcomes, including risk of complications, mortality and length of hospital stay. The length of stay is an important metric both for healthcare providers and patients, influenced by numerous factors. In particular, the length of stay in critical care is of great significance, both to patient experience and the cost of care, and is influenced by factors specific to the highly complex environment of the intensive care unit. The length of stay is often used as a surrogate for other outcomes, where those outcomes cannot be measured; for example as a surrogate for hospital or intensive care unit mortality. The length of stay is also a parameter, which has been used to identify the severity of illnesses and healthcare resource utilisation. This paper examines a range of length of stay and mortality prediction applications in acute medicine and the critical care unit. It also focuses on the methods of analysing length of stay and mortality prediction. Moreover, the paper provides a classification and evaluation for the analytical methods of the length of stay and mortality prediction associated with a grouping of relevant research papers published in the years 1984 to 2016 related to the domain of survival analysis. In addition, the paper highlights some of the gaps and challenges of the domain.

scholarly journals Employment status and its associated factor for patients 12 months after intensive care: Secondary analysis of the SMAP-HoPe-study

2021 ◽  
Author(s):  
Takeshi Unoki ◽  
Mio Kitayama ◽  
Hideaki Sakuramoto ◽  
Akira Ouchi ◽  
Tomoki Kuribara ◽  
...  
Keyword(s):  
Intensive Care ◽  
Depressive Symptoms ◽  
Physical Function ◽  
Employment Status ◽  
Depression Scale ◽  
Community Support ◽  
Financial Status ◽  
Icu Admission ◽  
Number Of Patients ◽  
Icu Discharge

AbstractReturning to work is a serious issue that affects patients who are being discharged from the intensive care unit (ICU). This study aimed to clarify the employment status and the perceived household financial status of ICU patients 12 months following discharge from the ICU. Additionally, a hypothesis of whether depressive symptoms were associated with subsequent unemployment status was tested. This study was a subgroup analysis using data from the published Survey of Multicenter Assessment with Postal questionnaire for Post-Intensive Care Syndrome (PICS) for Home Living Patients (the SMAP-HoPe study) in Japan. The patients included those who had a history of staying in the ICU for at least three nights and had been living at home for one year following discharge, between October 2019 and July 2020. We assessed employment status, subjective cognitive functions, household financial status, Hospital Anxiety and Depression Scale scores, and EuroQOL-5 dimensions of physical function at 12 months following intensive care. This study included 328 patients who were known to be employed prior to ICU admission. The median age was 64 (Interquartile Range [IQR] 52-72), and males were predominant (86%). Seventy-nine (24%) of those evaluated were unemployed. The number of patients who reported worsened financial status was significantly higher in the unemployed group. (p<.01) Multivariate analysis showed that higher age (Odds Ratio [OR]: 1.06, 95% Confidence Interval [CI]: 1.03-1.08]) and severity of depressive symptoms (OR: 1.13 [95% CI: 1.05-1.23]) were independent factors for employment status after 12 months from being discharged from the ICU. These factors were determined to be significant even after adjusting for sex, physical function, and cognitive function. We found that one-fourth of our patients who had been employed prior to ICU admission were subsequently unemployed 12 months following ICU discharge. Additionally, depressive symptoms were associated with unemployment status. The government and the local municipalities should provide medical and financial support to such patients. Additionally, community support for such patients is warranted.

scholarly journals Critical Care Demand and Intensive Care Supply for Patients in Japan with COVID-19 at the Time of the State of Emergency Declaration in April 2020: A Descriptive Analysis

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 530
Author(s):  
Yosuke Fujii ◽  
Kiichi Hirota
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Descriptive Analysis ◽  
State Of Emergency ◽  
Medical Institutions ◽  
Number Of Patients ◽  
Care Capacity

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic is overwhelming Japan’s intensive care capacity. This study aimed to determine the number of patients with COVID-19 who required intensive care and to compare the numbers with Japan’s intensive care capacity. Materials and Methods: Publicly available datasets were used to obtain the number of confirmed patients with COVID-19 undergoing mechanical ventilation and extracorporeal membrane oxygenation (ECMO) between 15 February and 19 July 2020 to determine and compare intensive care unit (ICU) and attending bed needs for patients with COVID-19, and to estimate peak ICU demands in Japan. Results: During the epidemic peak in late April, 11,443 patients (1.03/10,000 adults) had been infected, 373 patients (0.034/10,000 adults) were in ICU, 312 patients (0.028/10,000 adults) were receiving mechanical ventilation, and 62 patients (0.0056/10,000 adults) were under ECMO per day. At the peak of the epidemic, the number of infected patients was 651% of designated beds, and the number of patients requiring intensive care was 6.0% of ICU beds, 19.1% of board-certified intensivists, and 106% of designated medical institutions in Japan. Conclusions: The number of critically ill patients with COVID-19 continued to rise during the pandemic, exceeding the number of designated beds but not exceeding ICU capacity.

scholarly journals Collective Critical Care Ambulance: an innovative transportation of critical care patients by bus in COVID-19 pandemic response

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Thierry Lentz ◽  
Charles Groizard ◽  
Abel Colomes ◽  
Anna Ozguler ◽  
Michel Baer ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Life Support ◽  
Terrorist Attack ◽  
Real Life ◽  
Added Value ◽  
Long Distance ◽  
Icu Patients ◽  
Controlled Ventilation ◽  
Number Of Patients

Abstract Background During the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route. Methods The expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency. With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances. Results Four COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred. Conclusions It was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.

scholarly journals Protocol of mechanical ventilation and prevention of complications in critical care of patients with COVID-19: First version for Serbia

2020 ◽  
Vol 42 (1-2) ◽  
pp. 29-39
Author(s):  
Vojislava Nešković ◽  
Živadin Dobrosavljević ◽  
Goran Rondović ◽  
Ana Popadić ◽  
Aleksandar Vranjanac ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Symptoms ◽  
Myocardial Damage ◽  
Viral Pneumonia ◽  
World Health ◽  
Intensive Care Treatment ◽  
Number Of Patients ◽  
Health Organization

In December 2019, a new Corona virus (SARS-CoV-2) was identified as responsible for outbreak of viral pneumonia in Wuhan, Hubei Province, China. The World Health Organization has announced a pandemic of COVID-19 (Coronavirus disease 2019) on March 2nd 2020. COVID-19 is a respiratory infection where majority of patients have mild clinical symptoms. About 14% of patients require hospitalization and oxygen therapy and 5% of patients require admission to the intensive care unit. The most severe clinical cases include ARDS, sepsis and septic shock, acute renal failure, multiorgan dysfunction, and myocardial damage. Spread of the infection so far indicates that the number of patients requiring hospital admition and intensive care treatment will significantly burden the health care system in all countries. Several intensive and critical care protocols, based on the first experiences in treatment of viral pneumonia and severe COVID-19 illness, have already been published. Here we present the first version of a suggested protocol in our country, with an attached flowchart for the initial management of the COVID-19 patients in need for mechanical ventilation. The protocol is based on the worldwide existing experience in treatment of COVID-19 patients. The intention is not to replace the clinical experience and critical judgment of the attending doctors, but to strengthen their decisions and tailor treatment according to the recourses existing in our country.

Prognostic Factors Predicting Survival in De Novo AML Patients Requiring Intensive Care.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2860-2860
Author(s):  
Peter Schellongowski ◽  
Thomas Staudinger ◽  
Klaus Laczika ◽  
Gottfried Locker ◽  
Andja Bojic ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Respiratory Failure ◽  
De Novo ◽  
Prognostic Significance ◽  
Icu Admission ◽  
Saps Ii ◽  
Life Threatening ◽  
De Novo Aml

Abstract Acute myeloid leukemia (AML) is an acute life-threatening disease with variable clinical presentation. In this study, the percentage of patients (pts) with de novo AML requiring intensive care prior or during induction chemotherapy (ICT), as well as prognostic factors predicting survival in these pts were analyzed. A total of 471 consecutive pts (median age 62 years; range: 16–92) seen at the Vienna University Hospital between 1994–2006 were enrolled. In pts requiring critical care, simplified acute physiology score (SAPS) II as well as the need for invasive mechanical ventilation (IMV), vasopressor support (VP), and disease related markers were recorded at the intensive care unit (ICU). Eighty six percent (n=404) of all patients were eligible for ICT. Fifty four of these 404 patients (13.4%) required critical care prior or during ICT (median SAPS II 64, range 30–107), primarily due to respiratory failure (26 pts=48%) or life-threatening bleeding (12 pts=22%). Comparing ICU and non-ICU-pts with regard to disease-related markers, differences were found in white blood cell counts, WBC (ICU: 16.8 G/L; non-ICU: 11.9 G/L; p=0.084), whereas no differences were found regarding age, plt, and LDH. Forty pts received IMV (63%), and 32 VP (59%). The ICU survival rate was 41%. Significant prognostic factors with respect to ICU-survival were higher SAPS II scores (p<0.05), the need of IMV (p<0.05), and need of VP (p<0.05), whereas CRP, WBC, age, karyotype, or the time of admission to ICU (prior or during ICT) were not of prognostic significance. Survival was favourable in non-ICU-pts (median: 4.14 months; 22% at 8 years) compared to ICU-pts (median: 1.2 months; 9% at 8 years; p<0.05). Similar results were obtained when analyzing the overall survival, OS (non-ICU-pts: median: 4.1 months; 22% at 8 years; ICU-pts: median: 1.6 months; 12% at 8 years; p<0.05). Interestingly, the continuous complete remission, CCR (non-ICU-pts: 37% at 6 years; ICU-pts: 31% at 6 years; p>0.5) as well as OS of patients who had survived the first 28 days of therapy (non-ICU-pts: 29% at 6 years; ICU-pts: 20% at 6 years; p>0.5) did not differ significantly between ICU-pts and non-ICU-pts. With regard to OS, multivariate analysis revealed that ICU admission was an independent adverse prognostic parameter, as was a higher WBC, advanced age, higher LDH, or unfavourable karyotype. With regard to CCR, age and karyotype were independent prognostic variables, whereas ICU-admission was not of prognostic significance. In summary, 13% of pts with de novo AML eligible for ICT required critical care, primarily due to respiratory failure or bleeding. The probability of survival and OS of ICU-pts is inferior compared to non-ICU-pts. However, with regard to CCR and OS of pts surviving 28 days, no differences were observed between ICU-pts and non-ICU-pts. These observations favour the assumption that critical care should be considered in all de novo AML pts eligible for ICT.

Host Resistance in Patients after Resuscitation

1985 ◽  
Vol 1 (3) ◽  
pp. 219-223
Author(s):  
Laura Wolowicka ◽  
Hanna Bartkowiak ◽  
Ryszard Gorny
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Host Resistance ◽  
Multiple Injuries ◽  
Steady Increase ◽  
Trauma Patients ◽  
Abbreviated Injury Scale ◽  
Severe Injuries ◽  
Number Of Patients ◽  
Cellular Factors

There has recently been a steady increase in the number of patients treated in intensive care units (ICUs) and requiring resuscitation. This number has risen from 1 to 3% in patients after cardiac arrest (19) and from 7 to 13% in those with severe injuries (18). The immune system investigations, introduced more and more widely in intensive care medicine for prophylactic, therapeutic and prognostic reasons, did not, in principle, concern the cases of post-resuscitation disease after cardiac arrest. Only a few reports have been published on this subject (11).The aims of our investigations were the analysis of selected humoral and cellular factors in patients after cardiac arrest in comparison to those with multiple injuries, evaluation of the host resisctance against infection and of prognostic values of some immunological indices.Examinations were carried out in 50 patients, treated in an ICU of 15 beds, from 1981 to 1982, and in 20 healthy volunteers. The patients were divided into two main groups (Fig. 1): The first group consisted of 25 patients after cardiac arrest, age 47±12. The second group consisted of 25 patients after severe multiple injuries, age 42±18 y; they corresponded to an abbreviated injury scale (AIS) of 4–6 (8). 56% of the patients with cardiac arrest could not be resuscitated. In 64% of the trauma patients treatment was unsuccessful. Infection complications, influencing recovery were observed in 10 (40%) after cardiac arrest and in 12 (48%) after trauma. The cardiopulmonary-cerebral resuscitation methods used were standard (16).

Short-Term Ventilation of Critically Ill Patients in Recovery

2003 ◽  
Vol 13 (5) ◽  
pp. 214-217 ◽  
Author(s):  
David Ryan ◽  
Gillian Tobin
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Term ◽  
Recovery Unit ◽  
Number Of Patients ◽  
Care Facilities

There is often a shortfall of critical care facilities which can result in a number of patients who need management in intensive care units (ICUs) being treated in a recovery unit prior to being found an ICU bed. This article describes a study which examined this situation. The patients’ origins, durations of stay in recovery, outcomes and final destinations are discussed. The authors conclude that recovery provides a hidden resource to supplement the lack of intensive care beds and suggest ways that the problem might be addressed.

scholarly journals P0562DIFFERENT POTENTIAL INTERPRETATIONS OF CRITERIA FOR AKI WHEN USING AUTOMATED DECISION SUPPORT: IMPACT ON ASSOCIATED MORTALITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wim Van Biesen ◽  
Johan Steen ◽  
Johan Decruyenaere ◽  
Dominique Benoit ◽  
Eric Adriaan J Hoste ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Mortality Risk ◽  
Sofa Score ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Icu Admission ◽  
Definition Of ◽  
The Impact

Abstract Background and Aims The reported associated mortality risks of Acute Kidney Injury (AKI) in the intensive care unit (ICU) are variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of the definition, there is remaining variability in the actual implementation of this AKI definition, with variable use of the urinary output (UO) criterion, and different interpretations of the baseline serum creatinine (Screa). This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the associated ICU mortality risk of AKI stage 2 in the ICU. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all Screa data up to 1 year before ICU admission were retrieved from a dataset external to ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we either used a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we used either (in line with K-DIGO stage 2) a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Definition 8 and 9 identified patients who complied with at least one out of the Screa criteria 1-5 (def 8) or out of the UO criteria (def 9). Definition 10 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset comprised 16433 admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died in Intensive Care Unit (ICU). The SOFA score at admission was 6.9±4.1. The mortality risk associated with AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria (table). Most important, associated mortality risk was comparable whether a UO (RR 2.31, 95% CI 1.90-2.81) or a Screa (RR 2.00, 95% CI 1.57-2.55) criterium was used, and was highest in patients who complied with both at least one UO and one Screa criterium (RR 7.28, 95% CI 6.12-8.65). Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in AKI associated mortality risk. Omitting the UO criterium leads to substantial underestimation of associated risk.

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