RETROSPECTIVE ANALYSIS: A NOVEL LOOK AT QSOFA AND OTHER COMMON RISK FACTORS IN PREDICTING TRANSFER TO THE ICU FROM AN INTERMEDIATE CARE UNIT

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: The intermediate care unit (IMCU) is for patients who require a higher level of care than the acute medical/surgical floor but do not meet intensive care unit (ICU) criteria. Having a dedicated IMCU in the hospital has shown reduced mortality benefits, decreased health care costs, and utility optimization of the ICU. We aimed to see if there was any association between different variables which potentially could help dictate earlier ICU admission in select individuals. METHODS: This retrospective study included 113 patients admitted to the IMCU from May 2018 to November 2018. Demographics, admission diagnosis, vital signs, lactic acid, chemistries, and quick sequential organ failure assessment (qSOFA) scores were recorded. These characteristics were compared between patients who were transferred within 48 hours and who did not require ICU level of care. RESULTS: There were 55 patients who were transferred from the IMCU to the ICU within 48 hours of admission and 58 patients who did not require ICU level of care, which served as our control group. Analysis of the data showed 81.8% of patients who were transferred had qSOFA score greater than 1 compared to 34.5% patients in the control group (OR: 8.53, 95% CI [4.44 – 16.41], p-value < 0.001). Lactic acid levels greater than 2 was 41.8% in the transferred group and 13.8% in the control group (OR: 4.49, 95% CI [2.24 – 8.98], p-value < 0.001). Non-invasive positive pressure ventilation (NIPPV) use on admission was 27.2% in the transferred group and 3.4% in the control group (OR: 11.96, 95% CI [3.49 – 40.95], p-value < 0.001). History of organ failure was seen in 50.9% in the transferred group and 36.2% in the control group (OR: 1.85, 95% CI [1.05 – 3.26], p-value: 0.03). In the transferred group, 71.0% were identified to have 2 or more of the characteristics as mentioned above compared to 20.1% in the control group (OR: 9.73, 95% CI [5.07 – 18.69], p-value < 0.001). CONCLUSIONS: The patients with two or more of the characteristics (qSOFA score > 1, NIPPV use on admission, lactic acid > 2, and history of organ failure) recorded had a higher rate of transfer to the ICU within 48 hours of admission from IMCU. CLINICAL IMPLICATIONS: Patients who are admitted to the IMCU with 2 or more of either: elevated qSOFA scores, elevated lactic acid levels, NIPPV use prior to admission, or underlying history of organ failure were seen to have higher admissions to the ICU within 48 hours. Further studies should be done to see if these risk factors could be used for prognostic implications for patients who are admitted to the IMCU. Reference 1. Capuzzo M, et al. Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study. October 9, 2014; Crit Care: 18(5):551: https://doi.org/10.1186/s13054-014-0551-8. PMID: 25664865 DISCLOSURES: No relevant relationships by Rehman Ahmad, source=Web Response No relevant relationships by Zachary hansen, source=Web Response No relevant relationships by Patrick Huynh, source=Web Response No relevant relationships by Shu Xian Lee, source=Web Response No relevant relationships by Jin Lee, source=Web Response No relevant relationships by Tanna Lim, source=Web Response No relevant relationships by Nidhip Patel, source=Web Response