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Association of severity of illness and intensive care unit readmission: A systematic review.

ABSTRACT: To determine whether ICU readmission is associated with higher severity of illness scores in adult patients.Readmissions to the intensive care unit (ICU) are associated with increased costs, morbidity, and mortality.We performed searches of MEDLINE, EMBASE, and grey literature databases. We selected studies reporting data from adults who were hospitalized in an ICU, received severity of illness scores, and were discharged from the ICU. Characteristics of readmitted and non-readmitted patients were examined.We screened 4766 publications and included 31 studies in our analysis. In most studies, severity of illness scores were higher in patients readmitted to the ICU. Readmission was also associated with higher mortality and longer ICU and hospital stays. Excessive heterogeneity precluded the reporting of results in the form of a meta-analysis.ICU readmission is associated with higher severity of illness scores during the same hospitalization in adult patients.

SUBMITTER: Wong EG

PROVIDER: S-EPMC4692266 | biostudies-literature | 2016 Jan-Feb

REPOSITORIES: biostudies-literature

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Association of severity of illness and intensive care unit readmission: A systematic review.

Wong Evan G EG Parker Ann M AM Leung Doris G DG Brigham Emily P EP Arbaje Alicia I AI

Heart & lung : the journal of critical care 20160101 1

<h4>Objectives</h4>To determine whether ICU readmission is associated with higher severity of illness scores in adult patients.<h4>Background</h4>Readmissions to the intensive care unit (ICU) are associated with increased costs, morbidity, and mortality.<h4>Methods</h4>We performed searches of MEDLINE, EMBASE, and grey literature databases. We selected studies reporting data from adults who were hospitalized in an ICU, received severity of illness scores, and were discharged from the ICU. Charac ...[more]

PMID: 26702501

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Project description:Strained intensive care unit (ICU) capacity represents a fundamental supply-demand mismatch in ICU resources. Strain is likely to be influenced by a range of factors; however, there has been no systematic evaluation of the spectrum of measures that may indicate strain on ICU capacity.We performed a systematic review to identify indicators of strained capacity. A comprehensive peer-reviewed search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection was performed along with selected grey literature sources. We included studies published in English after 1990. We included studies that: (1) focused on ICU settings; (2) included description of a quality or performance measure; and (3) described strained capacity. Retrieved studies were screened, selected and extracted in duplicate. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was descriptive.Of 5297 studies identified in our search; 51 fulfilled eligibility. Most were cohort studies (n = 39; 76.5%), five (9.8%) were case-control, three (5.8%) were cross-sectional, two (3.9%) were modeling studies, one (2%) was a correlational study, and one (2%) was a quality improvement project. Most observational studies were high quality. Sixteen measures designed to indicate strain were identified 110 times, and classified as structure (n = 4, 25%), process (n = 7, 44%) and outcome (n = 5, 31%) indicators, respectively. The most commonly identified indicators of strain were ICU acuity (n = 21; 19.1% [process]), ICU readmission (n = 18; 16.4% [outcome]), after-hours discharge (n = 15; 13.6% [process]) and ICU census (n = 13; 11.8% [structure]). There was substantial heterogeneity in the operational definitions used to define strain indicators across studies.We identified and characterized 16 indicators of strained ICU capacity across the spectrum of healthcare quality domains. Future work should aim to evaluate their implementation into practice and assess their value for evaluating strategies to mitigate strain.This systematic review was registered at PROSPERO (March 27, 2015; CRD42015017931 ).

Dataset Information

Association of severity of illness and intensive care unit readmission: A systematic review.

Publications

Association of severity of illness and intensive care unit readmission: A systematic review.

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