Comparison of Risks Factors for Unplanned ICU Transfer after ED Admission in Patients with Infections and Those without Infections

Jeffrey Che-Hung Tsai,Ching-Wan Cheng,David Hung-Tsang Yen,Hsiu-Ling Chen,Chin-Yin Huang,Shao-Jen Weng

doi:10.1155/2014/102929

Abstract

Background. The objectives of this study were to compare the risk factors for unplanned intensive care unit (ICU) transfer after emergency department (ED) admission in patients with infections and those without infections and to explore the feasibility of using risk stratification tools for sepsis to derive a prediction system for such unplanned transfer. Methods. The ICU transfer group included 313 patients, while the control group included 736 patients randomly selected from those who were not transferred to the ICU. Candidate variables were analyzed for association with unplanned ICU transfer in the 1049 study patients. Results. Twenty-four variables were associated with unplanned ICU transfer. Sixteen (66.7%) of these variables displayed association in patients with infections and those without infections. These common risk factors included specific comorbidities, physiological responses, organ dysfunctions, and other serious symptoms and signs. Several common risk factors were statistically independent. Conclusions. The risk factors for unplanned ICU transfer in patients with infections were comparable to those in patients without infections. The risk factors for unplanned ICU transfer included variables from multiple dimensions that could be organized according to the PIRO (predisposition, insult/infection, physiological response, and organ dysfunction) model, providing the basis for the development of a predictive system.

Highlights

The emergency department (ED) is an important source of hospital inpatients, especially those with critical problems
Delgado et al found that respiratory tract infections, urinary tract infections, sepsis, and other acute infections are responsible for 26.9% of unplanned intensive care unit (ICU) transfers after ED admissions [4]
Of the 26,071 ED admissions, 627 underwent an unplanned ICU transfer within 48 hours; after excluding 314 of these patients based on our study criteria, 313 patients remained, comprising the ICU transfer group

Summary

Introduction

Many rules for stratifying the risk of ICU transfer in patients with sepsis have been advocated [5, 6] It is unknown if the risk factors for unplanned ICU transfer in patients with infections are the same as those in patients without infections. Our. The objectives of this study were to compare the risk factors for unplanned intensive care unit (ICU) transfer after emergency department (ED) admission in patients with infections and those without infections and to explore the feasibility of using risk stratification tools for sepsis to derive a prediction system for such unplanned transfer. Sixteen (66.7%) of these variables displayed association in patients with infections and those without infections These common risk factors included specific comorbidities, physiological responses, organ dysfunctions, and other serious symptoms and signs. The risk factors for unplanned ICU transfer included variables from multiple dimensions that could be organized according to the PIRO (predisposition, insult/infection, physiological response, and organ dysfunction) model, providing the basis for the development of a predictive system

Objectives

Results

Conclusion