Abstract Rationale Unplanned intubations occurring outside of a controlled environment (i.e., the intensive care unit ICU) are associated with a 50% mortality rate. Less comprehensive monitoring occurs on the floor, making the identification of clinical deterioration difficult. A prior descriptive study noted that 43% of patients did not have obvious abnormalities on vitals in the 24 hours preceding intubation. However, there are no studies directly comparing patients with unplanned intubation to those who are identified as at risk for intubation and transferred to a controlled setting (ICU) for intubation. Determining risk factors for unplanned intubation can help identify potentially modifiable factors for future interventions. Methods We conducted a case-control study of adult inpatients at a teaching community hospital who underwent intubation for respiratory compromise during hospitalization. Cases were patients who were intubated on the medical floor before transfer to the ICU. Controls (1 randomly selected per case) were patients intubated within 24 hours of transfer to the ICU. Patients who were intubated in the Emergency Department or within 24 hours of a procedure were excluded. Exposures and confounders evaluated included demographics, Charlson Comorbidity Index (CCI), Modified Early Warning Score (MEWS) on admission, reason for intubation (oxygenation, ventilation, airway protection, or multiple reasons), provider-specific characteristics, and day of event (weekday vs. weekend). Multiple logistic regression analysis was used to identify factors associated with being intubated on the medical floor (case status). Results From 1/1/2021-12/31/2022, 80 cases and 88 controls were selected after exclusion criteria were applied. The median age of cases was 73 (interquartile range IQR 66.5-79) and of controls was 72 (IQR 64-79) (P = 0.51). Among cases and controls, 35 (43.8%) and 36 (40.9%) were female, respectively (P = 0.71). After controlling for confounders including age, COVID-19 infection, CCI, and cardiac arrest at time of intubation, unplanned intubation on the medical floor was significantly associated with the following: MEWS score on admission (odds ratio OR 1.45, 95% confidence CI 1.11-1.90, P = 0.006), intubation for ventilation (OR 3.99, 95% CI 1.47-10.31, P = 0.006) or for multiple reasons (OR 3.71, 95% CI 1.52-9.02, P = 0.004). Conclusions Patients with unplanned intubation on the medical floor had higher MEWS on admission and were more likely to have ventilation or multifactorial reasons for intubation. These findings highlight the potential usefulness of integrating early warning score protocols to identify high-risk patients at admission and throughout hospitalization. Future quality improvement initiatives should evaluate whether enhanced surveillance or rapid-response activation criteria can reduce unplanned intubations. This abstract is funded by: None
Mitchell et al. (Fri,) studied this question.