Open AccessComparison of Unplanned Intensive Care Unit Readmission Scores: A Prospective Cohort Study
Author(s) -
Régis Goulart Rosa,
Cíntia Roehrig,
Roselaine Pinheiro de Oliveira,
Juçara Gasparetto Maccari,
Ana Carolina Peçanha Antônio,
Priscylla de Souza Castro,
Felippe Leopoldo Dexheimer Neto,
Patrícia de Campos Balzano,
Cassiano Teixeira
Publication year - 2015
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0143127
Subject(s) - medicine , sofa score , intensive care unit , emergency medicine , prospective cohort study , logistic regression , cohort , cohort study , intensive care medicine
Purpose Early discharge from the intensive care unit (ICU) may constitute a strategy of resource consumption optimization; however, unplanned readmission of hospitalized patients to an ICU is associated with a worse outcome. We aimed to compare the effectiveness of the Stability and Workload Index for Transfer score (SWIFT), Sequential Organ Failure Assessment score (SOFA) and simplified Therapeutic Intervention Scoring System (TISS-28) in predicting unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU. Methods We conducted a prospective cohort study in a single tertiary hospital in southern Brazil. All adult patients admitted to the ICU for more than 24 hours from January 2008 to December 2009 were evaluated. SWIFT, SOFA and TISS-28 scores were calculated on the day of discharge from the ICU. A stepwise logistic regression was conducted to evaluate the effectiveness of these scores in predicting unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU. Moreover, we conducted a direct accuracy comparison among SWIFT, SOFA and TISS-28 scores. Results A total of 1,277 patients were discharged from the ICU during the study period. The rate of unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU was 15% (192 patients). In the multivariate analysis, age ( P = 0.001), length of ICU stay ( P = 0.01), cirrhosis ( P = 0.03), SWIFT ( P = 0.001), SOFA ( P = 0.01) and TISS-28 ( P <0.001) constituted predictors of unplanned ICU readmission or unexpected death. The SWIFT, SOFA and TISS-28 scores showed similar predictive accuracy (AUC values were 0.66, 0.65 and 0.74, respectively; P = 0.58). Conclusions SWIFT, SOFA and TISS-28 on the day of discharge from the ICU have only moderate accuracy in predicting ICU readmission or death. The present study did not find any differences in accuracy among the three scores.