Clinical deterioration time out of the ICU and survival

Casuistic

Abstract

Introduction: most situations of vital risk are preceded by a detectable clinical deterioration. Late detection, delay in treatment and admission to the ICU is associated with a longer hospital stay and mortality. The rapid response teams are useful in these situations.
Objective: to assess the identification of critical patients in the general ward, the presence of “activation criteria” prior to admission in the ICU and its impact on the results.
Method: detection of activation criteria in the hours prior to admission to the ICU by analyzing the clinical record.
Results: 59 patients with clinical deterioration who were coming from the general ward were admitted in the ICU. This figure represented 13% of total admissions to the ICU. Median and standard deviation for age: 59 ± 17 years old and length of stay in the ICU 13 ± 21 days. 63% of them required mechanical ventilation and 43% required vasopressors. According to SAPS II, mean and standard deviation of 49 ± 24 vs 36 ± 23 for the general ICU population (p<0.001), mortality was 51% vs 24% (p<0.001) 43% presented an activation criteria in the 2 hours prior to admission, and 23% in the 48 hours prior to admission. Mortality increased with the presence of activation criteria within 24, 48 and 72 hours prior to admission. 58%, 62% and 78% respectively (p non-significant).
Conclusions: patients admitted to the ICU when they are transferred from the ward are in more severe a condition than the general population and they present a greater mortality. Mortality appears to increase with the delay in identifying clinical deterioration. Its early detection may be beneficial.