Key result
The RISC score predicted ICU readmission in surgical critical care patients with an area under the receiver operating characteristic curve of 0.78 (95% CI 0.74-0.82), outperforming existing scores.
Why the study?
ICU readmission carries high mortality and costs, but existing surgical ICU readmission prediction tools have limitations restricting their clinical implementation.
Does the RISC score accurately predict readmission to the ICU in surgical critical care patients compared to existing instruments?
Cohort (n=7,126)
No
Does the RISC score accurately predict readmission to the ICU in surgical critical care patients compared to existing instruments?
Effect estimate: AUC 0.78 (95% CI 0.74-0.82)
The RISC score is a clinically intuitive prediction instrument that accurately identifies surgical ICU patients at high risk for ICU readmission.
RISC may aid surgical ICU readmission risk stratification; prospective validation required before practice change.
BACKGROUND: Readmission to the Intensive Care Unit (ICU) is associated with a high risk of in-hospital mortality and higher health care costs. Previously published tools to predict ICU readmission in surgical ICU patients have important limitations that restrict their clinical implementation. We sought to develop a clinically intuitive score that can be implemented to predict readmission to the ICU after surgery or trauma. We designed the score to emphasize modifiable predictors. METHODS: In this retrospective cohort study, we included surgical patients requiring critical care between June 2015 and January 2019 at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA. We used logistic regression to fit a prognostic model for ICU readmission from a priori defined, widely available candidate predictors. The score performance was compared with existing prediction instruments. RESULTS: Of 7,126 patients, 168 (2.4%) were readmitted to the ICU during the same hospitalization. The final score included 8 variables addressing demographical factors, surgical factors, physiological parameters, ICU treatment and the acuity of illness. The maximum score achievable was 13 points. Potentially modifiable predictors included the inability to ambulate at ICU discharge, substantial positive fluid balance (>5 liters), severe anemia (hemoglobin <7 mg/dl), hyperglycemia (>180 mg/dl), and long ICU length of stay (>5 days). The score yielded an area under the receiver operating characteristic curve of 0.78 (95% CI 0.74-0.82) and significantly outperformed previously published scores. The performance of the underlying model was confirmed by leave-one-out cross-validation. CONCLUSION: The RISC-score is a clinically intuitive prediction instrument that helps identify surgical ICU patients at high risk for ICU readmission. The simplicity of the score facilitates its clinical implementation across surgical divisions.
No takes yet. Share an insight, caveat, or question.
Hammer et al. (2020) conducted a cohort in Surgical critical care patients (n=7,126). RISC Score vs. Existing prediction instruments was evaluated on ICU readmission (AUC 0.78, 95% CI 0.74-0.82). The RISC score predicted ICU readmission in surgical critical care patients with an area under the receiver operating characteristic curve of 0.78 (95% CI 0.74-0.82), outperforming existing scores.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: