What question did this study set out to answer?

To investigate clinical patterns and determinants of unplanned intensive care unit readmissions and identify patients at elevated risk.

February 13, 2014Hong Kong Medical JournalOpen Access

Characteristics of patients readmitted to intensive care unit: a nested case-control study

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Unplanned intensive care unit (ICU) readmission (n=438). Intervention: Positive fluid balance in the last 48 hours of index admission vs. Negative or neutral fluid balance. Primary outcome: Unplanned ICU readmission (OR 1.249, 95% CI 1.083-1.440, p=0.002).

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Key result

Positive fluid balance in the last 48 hours of index admission (OR 1.249) and higher base excess (OR 1.097) were significant independent predictors of unplanned ICU readmission.

Population

438 adult patients from a 20-bed mixed medical-surgical ICU in a tertiary hospital in Hong Kong. Cases and…

Design

Case-control

Follow-up

Index hospitalisation

Authors

OTOY TamPamela Youde Nethersole Eastern Hospital SLSM LamPamela Youde Nethersole Eastern Hospital HSHoi‐Ping ShumPamela Youde Nethersole Eastern Hospital

Discussion

Member takes

Implication

May inform discharge readiness assessment; leaves open whether fluid optimization prevents readmission in prospective trials.

Key Points

To investigate clinical patterns and determinants of unplanned intensive care unit readmissions and identify patients at elevated risk.
Conducted a nested case-referent study over a 30-month period at a tertiary hospital in Hong Kong.
Compared 146 patients with unplanned intensive care unit readmissions to 292 control patients discharged alive without readmission, matching 1:2 on age, gender, and disease severity.
Evaluated demographics, pre-discharge clinical metrics, and readmission causes using classification tree analysis.
The intensive care unit readmission rate was 5.1%, and readmitted patients experienced significantly higher mortality and longer mean hospital stays (both P<0.001).
Respiratory complications were the primary reason for readmission, accounting for 36.3% of all readmissions.
ICU readmission was independently linked to postoperative sepsis (adjusted P=0.043), pre-discharge 24-hour fluid gain in non-operative septic patients (adjusted P=0.013), and increased sputum volume at discharge in non-septic patients (adjusted P=0.006).

Study Design

Type

Case-Control (n=438)

Multicenter

Structured PICO

Population

438 critically ill patients (146 with unplanned ICU readmission and 292 matched controls) discharged alive from a tertiary hospital ICU in Hong Kong.

Outcome

Unplanned intensive care unit readmission during the same hospitalisation episodehard clinical

Main Result

Odds Ratio: 1.249 (95% CI 1.083–1.44)

p-value: p=0.002

Incomplete resolution of respiratory conditions, positive fluid balance, and excessive sputum quantity before ICU discharge are significant risk factors for unplanned ICU readmission.

Limitations

Data abstraction and categorisation processes were not blinded to the outcome status, making them prone to information bias.
Single-centre cohort, meaning differences in case-mix and patterns of readmission in different ICUs may limit generalizability.
Did not account for patients who had a poor physician-predicted chance of long-term survival and were therefore not readmitted.
Variables reflecting initial disease severity that might be associated with readmission could have been overlooked.

Cite This Study

Tam et al. (2014) conducted a case-control in Unplanned intensive care unit (ICU) readmission (n=438). Positive fluid balance in the last 48 hours of index admission vs. Negative or neutral fluid balance was evaluated on Unplanned ICU readmission (OR 1.249, 95% CI 1.083-1.440, p=0.002). Positive fluid balance in the last 48 hours of index admission (OR 1.249) and higher base excess (OR 1.097) were significant independent predictors of unplanned ICU readmission.

synapsesocial.com/papers/6a7c9f470bb6134e42cf7ff7 https://doi.org/10.12809/hkmj133973

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