Abstract
BackgroundMultiple predictive scores using Electronic Patient Record data have been developed for hospitalised patients at risk of clinical deterioration. Methods used to select patient centred variables for inclusion in these scores varies. We performed a systematic review to describe univariate associations with unplanned Intensive Care Unit (ICU) admission with the aim of assisting model development for future scores that predict clinical deterioration.MethodsData sources were MEDLINE, EMBASE, CINAHL, CENTRAL and the Cochrane Database of Systematic Reviews. Included studies were published since 2000 describing an association between patient centred variables and unplanned ICU admission determined using univariate analysis. Two authors independently screened titles, abstracts and full texts against inclusion and exclusion criteria. DistillerSR (Evidence Partners, Canada, Ottawa, Ontario) software was used to manage the data and identify duplicate search results. All screening and data extraction forms were implemented within DistillerSR. Study quality was assessed using an adapted version of the Newcastle-Ottawa Scale. Variables were analysed for strength of association with unplanned ICU admission.ResultsThe database search yielded 1520 unique studies; 1462 were removed after title and abstract review; 57 underwent full text screening; 16 studies were included. One hundred and eighty nine variables with an evaluated univariate association with unplanned ICU admission were described.DiscussionBeing male, increasing age, a history of congestive cardiac failure or diabetes, a diagnosis of hepatic disease or having abnormal vital signs were all strongly associated with ICU admission.ConclusionThese findings will assist variable selection during the development of future models predicting unplanned ICU admission.Trial registrationThis study is a component of a larger body of work registered in the ISRCTN registry (ISRCTN12518261).
Highlights
Multiple predictive scores using Electronic Patient Record data have been developed for hospitalised patients at risk of clinical deterioration
Statement of findings In this systematic review of 16 observational and cohort studies evaluating Emergency Department (ED) and ward patients, we found two comorbidities, two demographics, one diagnosis and six vital signs with a strong univariate association with unplanned Intensive Care Unit (ICU) admission
Overall this review provides a thorough summary of the candidate variables available in Electronic Patient Record (EPR) that will assist researchers to develop and evaluate predictive models for patients at risk of unplanned ICU admission
Summary
Multiple predictive scores using Electronic Patient Record data have been developed for hospitalised patients at risk of clinical deterioration. Scores that predict risk for clinical deterioration in hospitalised patients have evolved from vital sign based Early Warning Scores (EWS) to systems that utilise the large amount of patient centred data in Electronic Patient Records (EPRs) [1,2,3,4]. Each of the current, published experimental models were derived and validated on large EPR linked databases that used Intensive Care Unit (ICU) admission as one of the outcome measures This outcome measure is commonly used (along with death and cardiac arrest) as a surrogate for confirmed clinical deterioration. Regardless of the method, the goal is to include the optimal combination of variables that maximise predictive ability, whilst avoiding unnecessary complexity [6]
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