Severity of Illness Scoring Systems in Critical Care

2015 ◽  
Author(s):  
Mark T. Keegan
Keyword(s):  
United States ◽  
Critical Care ◽  
Organ Failure ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
The United States ◽  
Prognostic Models ◽  
Fourth Generation ◽  
Risk Of Death ◽  
Predicted Risk

Critical care consumes about 4% of national health expenditure and 0.65% of United States gross domestic product. There are approximately 94,000 critical care beds in the United States, and provision of critical care services costs approximately $80 billion per year. The enormous costs and the heterogeneity of critical care have led to scrutiny of patient outcomes and cost-effectiveness by a variety of governmental and nongovernmental organizations; furthermore, individual critical care practitioners and their hospitals should evaluate the care delivered. This review discusses scoring systems in medicine, critical care systems, development, validation, performance, and customization of the models, adult intensive care unit (ICU) prognostic models, model use, limitations, prognostic models in trauma care, perioperative scoring systems, assessment of organ failure, severity of illness and organ dysfunction scoring in children, and future directions. Figures show the distribution of predicted risk of death using two different prediction models among a population of patients who ultimately are observed to either live or die, a comparison of  “expected” deaths (based on the expectation that the predicted probability from the model is correct) to observed deaths within each of the 10 deciles of predicted risk, the importance of disease in the risk of death equation,  and the revised Rapaport-Teres graph for ICUs in the Project IMPACT validation set. Tables list three main ICU prognostic models, study characteristics and performance of the fourth-generation prognostic models, variables included in the fourth-generation prognostic models, potential uses of adult ICU prognostic models, variables included in the calculation of the organ failure scores, and sequential organ failure assessment. This review contains 4 highly rendered figures, 6 tables, and 293 references

Severity of Illness Scoring Systems in Critical Care

2015 ◽  
Author(s):  
Mark T. Keegan
Keyword(s):  
United States ◽  
Critical Care ◽  
Organ Failure ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
The United States ◽  
Prognostic Models ◽  
Fourth Generation ◽  
Risk Of Death ◽  
Predicted Risk

Critical care consumes about 4% of national health expenditure and 0.65% of United States gross domestic product. There are approximately 94,000 critical care beds in the United States, and provision of critical care services costs approximately $80 billion per year. The enormous costs and the heterogeneity of critical care have led to scrutiny of patient outcomes and cost-effectiveness by a variety of governmental and nongovernmental organizations; furthermore, individual critical care practitioners and their hospitals should evaluate the care delivered. This review discusses scoring systems in medicine, critical care systems, development, validation, performance, and customization of the models, adult intensive care unit (ICU) prognostic models, model use, limitations, prognostic models in trauma care, perioperative scoring systems, assessment of organ failure, severity of illness and organ dysfunction scoring in children, and future directions. Figures show the distribution of predicted risk of death using two different prediction models among a population of patients who ultimately are observed to either live or die, a comparison of  “expected” deaths (based on the expectation that the predicted probability from the model is correct) to observed deaths within each of the 10 deciles of predicted risk, the importance of disease in the risk of death equation,  and the revised Rapaport-Teres graph for ICUs in the Project IMPACT validation set. Tables list three main ICU prognostic models, study characteristics and performance of the fourth-generation prognostic models, variables included in the fourth-generation prognostic models, potential uses of adult ICU prognostic models, variables included in the calculation of the organ failure scores, and sequential organ failure assessment.   This review contains 4 highly rendered figures, 6 tables, and 293 references

scholarly journals Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States*

2015 ◽  
Vol 43 (10) ◽  
pp. 2066-2075 ◽  
Author(s):  
Viranuj Sueblinvong ◽  
Daniel W. Johnson ◽  
Gary L. Weinstein ◽  
Michael J. Connor ◽  
Ian Crozier ◽  
...  
Keyword(s):  
United States ◽  
Critical Care ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Ebola Virus ◽  
Virus Disease ◽  
The United States ◽  
Multiple Organ ◽  
Ebola Virus Disease

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

Regionalization of Critical Care in the United States

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sharon Leung ◽  
Stephen M. Pastores ◽  
John M. Oropello ◽  
Craig M. Lilly ◽  
Samuel M. Galvagno ◽  
...  
Keyword(s):  
United States ◽  
Critical Care ◽  
The United States

scholarly journals Advances in the Management of Sepsis and the Understanding of Key Immunologic Defects

2011 ◽  
Vol 115 (6) ◽  
pp. 1349-1362 ◽  
Author(s):  
Lee P. Skrupky ◽  
Paul W. Kerby ◽  
Richard S. Hotchkiss
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Operating Room ◽  
The United States ◽  
Difficult Problem ◽  
Treatment Algorithms ◽  
New Treatment ◽  
Overall Mortality

Anesthesiologists are increasingly confronting the difficult problem of caring for patients with sepsis in the operating room and in the intensive care unit. Sepsis occurs in more than 750,000 patients in the United States annually and is responsible for more than 210,000 deaths. Approximately 40% of all intensive care unit patients have sepsis on admission to the intensive care unit or experience sepsis during their stay in the intensive care unit. There have been significant advances in the understanding of the pathophysiology of the disorder and its treatment. Although deaths attributable to sepsis remain stubbornly high, new treatment algorithms have led to a reduction in overall mortality. Thus, it is important for anesthesiologists and critical care practitioners to be aware of these new therapeutic regimens. The goal of this review is to include practical points on important advances in the treatment of sepsis and provide a vision of future immunotherapeutic approaches.

scholarly journals Older Adults in the United States and COVID-19: A Qualitative Study of Perceptions, Finances, Coping, and Emotions

2021 ◽  
Vol 9 ◽  
Author(s):  
R. Turner Goins ◽  
Elizabeth Anderson ◽  
Hannah Minick ◽  
Heather Daniels
Keyword(s):  
Mental Health ◽  
United States ◽  
Older Adults ◽  
News Media ◽  
Emotional Health ◽  
The United States ◽  
Stress Appraisal ◽  
Risk Of Death ◽  
Increased Risk ◽  
Precautionary Measures

Introduction: Older adults have the poorest coronavirus (COVID-19) prognosis with the highest risk of death due to complications, making their COVID-19 experiences particularly important. Guided by the stress-appraisal-coping theoretical model, we sought to understand COVID-related perceptions and behaviors of older adults residing in the United States.Materials and Methods: We used convenience sampling to recruit persons with the following inclusion criteria: Aged ≥ 65 years, English fluency, and U.S. residency. Semi structured in-depth interviews were conducted remotely and audio recorded between April 25, 2020 and May 7, 2020. Interviews were professionally transcribed with a final study sample of 43. A low-inference qualitative descriptive design was used to provide a situated understanding of participants' life experiences using their naturalistic expressions.Results: The mean age of participants was 72.4 ± 6.7. Slightly over half were female (55.8%), 90.6% were White, and 18.6% lived alone. The largest percentages of participants resided in a rural area (27.9%) or small city (25.6%). We identified four themes, including (1) risk perception, (2) financial impact, (3) coping, and (4) emotions. Most participants were aware of their greater risk for poor COVID-19 outcomes but many did not believe in their increased risk. Financial circumstances because of the pandemic varied with largely no financial impacts, while others reported negative impacts and a few reported positive impacts. Coping was problem- and emotion-focused. Problem-focused coping included precautionary efforts and emotion-focused coping included creating daily structure, pursuing new and/or creative activities, connecting with others in new ways, and minimizing news media exposure. Overall, emotional health was negatively affected by the pandemic although some participants reported positive emotional experiences.Conclusions: Perceiving themselves as high risk for COVID-19 complications, older adults used precautionary measures to protect themselves from contracting the virus. The precautionary measures included social isolation, which can negatively affect mental health. Older adults will need to be resourceful and draw on existing resources to cope, such as engaging in creative activities and new strategies to connect with others. Our findings underscore the importance of the preservation of mental health during extended periods of isolation by taking advantage of low-to-no-cost existing resources.

scholarly journals The Impact of Antihypertensive Drugs on the Number and Risk of Death, Stroke and Myocardial Infarction in the United States

2006 ◽  
Author(s):  
Genia Long ◽  
David Cutler ◽  
Ernst Berndt ◽  
Jimmy Royer ◽  
Andrée-Anne Fournier ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Antihypertensive Drugs ◽  
The United States ◽  
Risk Of Death ◽  
The Impact

Neonatal Personpower

PEDIATRICS ◽  
1987 ◽  
Vol 79 (5) ◽  
pp. 836-837
Author(s):  
GERALD KATZMAN
Keyword(s):  
United States ◽  
Critical Care ◽  
The United States ◽  
Care Needs ◽  
Live Births ◽  
Adequate Number ◽  
Lengths Of Stay ◽  
The Difference ◽  
Power Needs

To the Editor.— There have been several attempts to define the person-power needs for neonatologists in the United States.1-3 The reports by Merenstein et al2 and the AAP Committee on Fetus and Newborn1 maintain that there is presently an adequate number of neonatologists, whereas in a 1981 editorial, Robertson3 predicted increasing shortages of neonatologists. Why the difference between the conclusions? My answer to this question is that the reports by Merenstein et al and the AAP used calculated ratios of neonatologists to live births or lengths of stay, whereas the Robertson editorial expressed concern about the critical care needs of the physiologically unstable neonate.

Workforce demographics and unit structure in paediatric cardiac critical care in the United States

2021 ◽  
pp. 1-5
Author(s):  
Robin V. Horak ◽  
Shasha Bai ◽  
Bradley S. Marino ◽  
David K. Werho ◽  
Leslie A. Rhodes ◽  
...  
Keyword(s):  
United States ◽  
Critical Care ◽  
Heart Surgery ◽  
Age Groups ◽  
The United States ◽  
Work Hours ◽  
Full Time ◽  
Full Time Equivalent ◽  
Unit Structure ◽  
Cardiac Critical Care

Abstract Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

Sign in / Sign up

Export Citation Format

Share Document