Value of Risk Stratification Scores in Predicting Length of Stay Outcomes for Patients Admitted to the Intensive Care Unit With Gastrointestinal Bleeding

Abstract

Introduction: To assess the value of risk stratification scores in predicting length of stay (LOS) outcomes for patients admitted to an intensive care unit (ICU) with a primary diagnosis of gastrointestinal (GI) bleeding in a community teaching hospital. Methods: This was a prospective study of all new cases of GI bleeding in patients admitted to an ICU at Lutheran medical center from January to May of 2014. Patients were included if they were older than 18, admitted directly to an ICU from the emergency department, had a hemoglobin (Hg) value of less than 10 gm/dL or a drop in baseline Hg of at least 2 gm/dL. Patients who were pregnant or had bleeding disorders were excluded. The data for each patients’ first day in the ICU was used to calculate APACHE II and Charlson scores. A Rockall score was computed after endoscopic findings were obtained. Results: We used APACHE II and Charlson scores to evaluate the role of comorbid conditions in outcomes for patients admitted for GI bleeding into the ICU in first 24 hours. Rockall scoring was used to evaluate risk of mortality and re-bleeding during hospital course. A total of 51 patients were included in the study with a mean age of 67 years (range 20-95). Of the patients, 34/51(67%) of patients were male and 17/51 (33%) were female. Mean LOS in the ICU was 4.01 days, whereas the mean overall hospital stay was 9.50 days. Using SPSS 7.0, we calculated a Pearson correlation (r) to assess any linear correlation between LOS and each independent scoring system. Our analysis revealed that the Charlson score had a negative correlation with LOS in the ICU with r=-0.20. For patients with a Charlson score of 4 or less, LOS in the ICU and overall hospital stay was lower 3.22 days and 8.86 days respectively. The Rockall score and APACHE II had a positive correlation with regard to LOS in the ICU, r=+0.18 and r=+0.20 respectively. Similarly, for patients with a Rockall score of 5 or more and an APACHE II score of 13 or more, there was an increase in ICU LOS (4.96 and 4.09 days); and overall hospital stay of 11.70 and 11.21 days respectively. Conclusion: Though uncommonly applied to patients admitted to the ICU for GI bleeding, risk stratification scores such as the Charlson, Rockall and APACHE II may be helpful in the future to predict LOS in the ICU as well as for the overall hospital stay. Conversely, patients with lower scores in all three scoring systems may require fewer days in the ICU. Though further studies are needed for validation of these risk stratification scores for this purpose, we found them to be helpful in identifying more complex patients who required more intensive care time in our community hospital setting.