• Thomas F Byrd, Tom A Phelan, Nicholas E Ingraham, Benjamin W Langworthy, Ajay Bhasin, Abhinab Kc, Genevieve B Melton-Meaux, and Christopher J Tignanelli.
• Division of Hospital Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN.
• Crit. Care Med. 2024 Sep 1; 52 (9): e439e449e439-e449.

ObjectivesTo develop an electronic descriptor of clinical deterioration for hospitalized patients that predicts short-term mortality and identifies patient deterioration earlier than current standard definitions.DesignA retrospective study using exploratory record review, quantitative analysis, and regression analyses.SettingTwelve-hospital community-academic health system.PatientsAll adult patients with an acute hospital encounter between January 1, 2018, and December 31, 2022.InterventionsNot applicable.Measurements And Main ResultsClinical trigger events were selected and used to create a revised electronic definition of deterioration, encompassing signals of respiratory failure, bleeding, and hypotension occurring in proximity to ICU transfer. Patients meeting the revised definition were 12.5 times more likely to die within 7 days (adjusted odds ratio 12.5; 95% CI, 8.9-17.4) and had a 95.3% longer length of stay (95% CI, 88.6-102.3%) compared with those who were transferred to the ICU or died regardless of meeting the revised definition. Among the 1812 patients who met the revised definition of deterioration before ICU transfer (52.4%), the median detection time was 157.0 min earlier (interquartile range 64.0-363.5 min).ConclusionsThe revised definition of deterioration establishes an electronic descriptor of clinical deterioration that is strongly associated with short-term mortality and length of stay and identifies deterioration over 2.5 hours earlier than ICU transfer. Incorporating the revised definition of deterioration into the training and validation of early warning system algorithms may enhance their timeliness and clinical accuracy.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

23 keywords...

hide…