Presented at the Society for Academic Emergency Medicine annual meeting, New Orleans, LA, May 2009.
Identifying Infected Emergency Department Patients Admitted to the Hospital Ward at Risk of Clinical Deterioration and Intensive Care Unit Transfer
Article first published online: 12 OCT 2010
© 2010 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 17, Issue 10, pages 1080–1085, October 2010
How to Cite
Kennedy, M., Joyce, N., Howell, M. D., Lawrence Mottley, J. and Shapiro, N. I. (2010), Identifying Infected Emergency Department Patients Admitted to the Hospital Ward at Risk of Clinical Deterioration and Intensive Care Unit Transfer. Academic Emergency Medicine, 17: 1080–1085. doi: 10.1111/j.1553-2712.2010.00872.x
Dr. Shapiro is supported in part by grants from the National Institutes of Health; National Heart, Lung, and Blood Institute HL091757; and National Institute of General Medical Sciences GM076659.
Supervising Editor: Nina Gentile, MD.
- Issue published online: 12 OCT 2010
- Article first published online: 12 OCT 2010
- Received November 27, 2009; revision received February 6, 2010; accepted February 12, 2010.
- risk assessment;
- emergency service, hospital;
- intensive care units;
- patient transfer;
- critical care, sepsis;
Objectives: An important challenge faced by emergency physicians (EPs) is determining which patients should be admitted to an intensive care unit (ICU) and which can be safely admitted to a regular ward. Understanding risk factors leading to undertriage would be useful, but these factors are not well characterized.
Methods: The authors performed a secondary analysis of two prospective, observational studies of patients admitted to the hospital with clinically suspected infection from an urban university emergency department (ED). Inclusion criteria were as follows: adult ED patient (age 18 years or older), ward admission, and suspected infection. The primary outcome was transfer to an ICU within 48 hours of admission. Using multiple logistic regression, independent predictors of early ICU transfer were identified, and the area under the curve for the model was calculated.
Results: Of 5,365 subjects, 93 (1.7%) were transferred to an ICU within 48 hours. Independent predictors of ICU transfer included respiratory compromise (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.4 to 4.3), congestive heart failure (CHF; OR = 2.2, 95% CI = 1.4 to 3.6), peripheral vascular disease (OR = 2.0, 95% CI = 1.1 to 3.7), systolic blood pressure (sBP) < 100 mm Hg (OR = 1.9, 95% CI = 1.2 to 2.9), heart rate > 90 beats/min (OR = 1.8, 95% CI = 1.1 to 2.8), and creatinine > 2.0 (OR = 1.8, 95% CI = 1.1 to 2.8). Cellulitis was associated with a lower likelihood of ICU transfer (OR = 0.33, 95% CI = 0.15 to 0.72). The area under the curve for the model was 0.73, showing moderate discriminatory ability.
Conclusions: In this preliminary study, independent predictors of ICU transfer within 48 hours of admission were identified. While somewhat intuitive, physicians should consider these factors when determining patient disposition.
ACADEMIC EMERGENCY MEDICINE 2010; 17:1080–1085 © 2010 by the Society for Academic Emergency Medicine