The utility of severity scoring systems to identify obstetric transports at risk for ICU escalation

Elsamadicy, Emad; Plotnikova, Anya; Yang, Jerry; Gambhir, Vainavi; Zahid, Manahel; Pirzada, Saad; Tran, Quincy; Lankford, Allison

doi:10.1016/j.ajog.2022.11.528

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“…Most peripartum IHT patients were transferred for either fetus or delivery-related care, and they were mostly transferred to a labor and delivery (L&D) unit. There was a very small number of patients who were subsequently upgraded to ICU-level of care and their demographics and clinical outcomes were described [ 7 ]. However, characteristics of patients who were transferred directly from other hospitals to an ICU at a tertiary care center has not been described.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and outcomes of obstetric patients transferred directly to intensive care units

Pirzada,

Boswell,

Yang

et al. 2024

ACC

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Background: Medical complications in peripartum patients are uncommon; however, such events in patients already under biological stress can lead to poor outcomes. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study looked at peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center.Methods: We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (ICU LOS) and hospital length of stay (HLOS).Results: Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average age was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1–4.25) and median Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7–12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (2–12) and 8 days (5–17). High SOFA was linked to longer HLOS, as was APACHE II score.Conclusions: Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings.

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Section: Introductionmentioning

confidence: 99%