Abstract Introduction Rapid Response Teams (RRT) often encounter patients who need either urgent intervention or to be transitioned to a critical care unit. The Modified Shock Index (MSI) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores are commonly used scoring systems that correlate with mortality in Medical Intensive Care Unit (MICU) settings. However, their applications in patients who require an RRT within 24 hours of admission and in patients who are admitted to a Cardiac Intensive Care Unit (CICU) have yet to be assessed. Purpose We retrospectively evaluated patients who experienced clinical decompensation within 24 hours of admission requiring an RRT to see if MSI correlated with clinical deterioration and if APACHE II predicted mortality in CICU patients. Methods A retrospective analysis was performed on 360 patients who had an RRT called within 24 hours of admission at an urban, academic, tertiary center from February 2022 to August 2023. Demographic and clinical variables, including MSI and APACHE II scores, were analyzed using T-test, chi-square test, and linear regression, as appropriate. Results The median age of the population was 70.9 years; 173 (48.1%) were male, and 200 (55.5%) were white (Table 1). MSI for the cohort increased significantly between presentation to the emergency department and immediately prior to RRT (1.005 vs. 1.208, p 0.0001) (Figure 1a). There was no significant difference between MSI scores from initial presentation and inpatient admission to a medicine service (1.005 vs. 0.984, p=0.356). 72 (20.0%) patients were admitted to the MICU and 25 (6.9%) patients were admitted to the CICU. MSI significantly increased between presentation and prior to RRT activation for patients requiring the MICU (0.993 vs. 1.193, p0.0001) and CICU (0.988 vs. 1.329, p=0.022), respectively. While APACHE II scores were positively correlated with mortality for MICU patients (p=0.0005), they did not correlate with mortality for patients admitted to the CICU (p=0.646) (Figure 1b). Conclusion While APACHE II predicted mortality in the MICU cohort, it performed barely better than chance in patients admitted to the CICU. MSI increased significantly from admission to prior to RRT. Clinical deterioration occurred between admission and inpatient assessment, presenting the opportunity to utilize MSI as a screening tool to identify patients who may require more urgent evaluation to prevent further deterioration and need for an RRT. Further studies are needed to better identify patients prior to clinical decompensation requiring RRTs and to assess APACHE II validity within CICU patients.Table 1:Demographic Information Figure 1:APACHE and MSI in ICU and RRT
Lin et al. (Sat,) studied this question.