Association between prioritization level at intensive care unit admission and hospital outcome
DOI:
https://doi.org/10.5433/1679-0367.2022v43n2p243Keywords:
Classification; Prognosis, Treatment outcome, Admission, Intensive care unitAbstract
Objective: To assess the association between levels of prioritization for admission to intensive care unit (ICU) and patients’ prognosis.
Material and Method: Longitudinal retrospective study that included adult patients admitted to the ICU of a University Hospital during 2020. The data were collected from paper and electronic medical records, including identification, date of admission to the hospital, date of admission to ICU, diagnosis, medical history, date of hospital discharge, outcome, the Simplified Acute Physiology Score 3 (SAPS-3) and prioritization level. Results: The study evaluated 274 patients during 2020. Respiratory diseases represented 41,25% of admissions, COVID-19 being the most frequent diagnosis (totaling 65 confirmed and 2 suspected cases). Among the comorbidities, the following were highlighted: Arterial hypertension (64,32%), diabetes mellitus (25,82%), and smoking (18,78%). The mean SAPS 3 score was 59,29 points, representing a probability of death of 39,00%. About prioritization levels, 174 (63,50%) patients were categorized as Priority 1 (P1); 94 (34,31%) patients as Priority 2 (P2) and 6 (2,19%) patients as Priority 3 (P3), which was not considered due to insufficient sample for testing. Comparing groups P1 and P2, the probability of death of each category was, respectively, 51,95% and 13,75%. During the study period, the number of deaths in each category was 90 (60,81%) for P1 and 19 (25,30%; p<0,001) for P2. Conclusion: The prioritization classification identified patients with more severity and with greater mortality rates in category P1 of prioritization to ICU admission, even though there was no difference on age, comorbidity and frailty.
References
Alves CJ, Franco GPP, Nakata CT, Costa GLG, Costa GLG, Genaro MS, et al. Avaliação de índices prognósticos para pacientes idosos ad¬mitidos em unidades de terapia intensiva. Rev Bras Ter Intens. 2009;21(1):1-8. doi: 10.1590/S0103-507X2009000100001.
Barfod C, Lauritzen MMP, Danker JK, Sölétormos G, Forberg JL, Berlac PA, et al. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012;20:28. doi: 10.1186/1757-7241-20-28.
Caldeira VMH, Silva Júnior JM, Oliveira AMRR, Rezende S, Araújo LAG, Santana MRO, et al. Critérios para admissão de pa¬cientes na unidade de terapia intensiva e mortalidade. Rev Assoc Med Bras. 2010;56(5):528-34. doi: 10.1590/S0104-42302010000500012.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8.
Cohen RI, Eichorn A, Silver A. Admission decisions to a medical intensive care unit are based on functional status rather than severity of illness. A single center experi¬ence. Minerva Anestesiol [Internet]. 2012 [cited 2022 oct 10]; 78(11):1226-33. Available from: https://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2012N11A1226
Conselho Federal de Medicina (BR). Resolução CFM nº 2.156/2016, de 28 de outubro de 2016. Estabelece os critérios de admissão e alta em unidade de terapia intensiva [Internet]. Brasília; 2016 [citado 2022 out 10]. Disponível em: https://sistemas.cfm.org.br/normas/visualizar/resolucoes/BR/2016/2156
Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, et al. Severe metabolic or mixed acidemia on intensive care unit admis¬sion: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care. 2011;15(5):R238. doi: 10.1186/cc10487.
LaMantia MA, Stewart PW, Platts-Mills TF, Biese KJ, Forbach C, Zamora E, et al. Pre-dictive value of initial triage vital signs for critically ill older adults. West J Emerg Med. 2013;14(5):453-60. doi: 10.5811/westjem.2013. 5.13411.
Metnitz PGH, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3-From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive Care Med. 2005;31(10):1336-44. doi: 10.1007/s00134-005-2762-6.
Ministério da Saúde - MS (BR). Projeto Ava-liação do Desempenho do Sistema de Saúde. (PROADESS). Monitoramento da assistência hospitalar no Brasil - 2009-2017. Boletim Informativo do PROADESS, nº 4, fev./2019 [Internet]. 2019 [citado 2022 out 28]. Disponí-vel em: https://www.proadess.icict.fiocruz.br/Boletim_4_PROADESS_Monitoramento da assistencia hospitalar_errata_1403.pdf
Moreno RP, Metnitz PGH, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3 - From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31(10): 345-55. doi: 10.1007/s00134-005-2763-5.
Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016; 44(8):1553-602. doi: 10.1097/CCM.0000000000001856.
Nordberg M, Lethvall S, Castrén M. The validity of the triage system ADAPT. Scand J Trauma Resusc Emerg Med. 2010;18(Suppl 1):S36. doi: 10.1186/1757-7241-18-S1-P36.
Sprung CL, Danis M, Iapichino G, Artigas A, Kesecioglu J, Moreno R, et al. Triage of intensive care patients: Identifying agreement and controversy. Intensive Care Med. 2013; 39(11):1916-24. doi: 10.1007/s00134-013-3033-6.
Vermillion SA, Hsu FC, Dorrell RD, Shen P, Clark CJ. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol. 2017;115(8): 997-1003. doi: 10.1002/jso.24617.
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