Ward Mortality After ICU discharge: a Multicenter validation Of The Sabadell Score

Fernández, Rafael; Serrano, José Manuel Flores; Umaran, Isabel; Abizanda, R.; Carrillo, Andrés; López-Pueyo, María Jesús; Sedes, Pedro Rascado; Balerdi, B.; Suberviola, Borja; Hernández, Gonzalo

doi:10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a4091

Cited by 3 publications

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“…22 Therefore, the relationship between the Sabadell score and readmission as a possible endpoint was plausible. Actually, our observed mortality associated with Sabadell score strata is similar to that in a previous report, 8 and the observed AUC is similar to that described for the Stability and Workload Index for Transfer (SWIFT) score, a predictive tool for ICU readmission. 23 A recent systematic review of published tools to predict adverse events (i.e., ICU readmission, death after ICU discharge, or medical emergency team activation) revealed a single tool (the Minimizing ICU Readmission score) that could predict both post-ICU discharge mortality and readmission.…”

Section: Discussionsupporting

confidence: 89%

“…Our results corroborate this hypothesis as previously demonstrated in a multicenter Spanish cohort. 8 Our study has several limitations. First, it was a single-center prospective analysis of a private tertiary-care oncology center, which might limit the generalizability of our findings and our sample size.…”

Section: Discussionmentioning

confidence: 91%

“…7,8 However, ICU readmission is associated with post-ICU death. 3,4,8 A recent European Society of Intensive Care Medicine report suggests that this metric can serve as a quality indicator 15 because some deaths associated with readmission are thought to be preventable. 22 Therefore, the relationship between the Sabadell score and readmission as a possible endpoint was plausible.…”

Section: Discussionmentioning

confidence: 99%

“…At ICU discharge, the attending intensivist scored the patient's subjective prognosis as reported in the Sabadell score. 7,8 Mutually exclusive groups of patients were defined as follows: score of 0, good prognosis in the long term (>6 months); score of 1, poor prognosis in the long term (>6 months) and suitable for ICU readmission without restrictions; score of 2, poor prognosis in the short term (<6 months) and with debatable suitability for ICU readmission; and score of 3, not expected to survive the hospital stay. The Sabadell score is entirely subjective and integrates the physician's knowledge and impression about the patient's condition, previous performance before ICU admission, and medical history during the healthcare facility stay.…”

Section: Methodsmentioning

confidence: 99%

“…6 In fact, the Sabadell score is a subjective tool for prediction of the post-ICU prognosis that exhibits good discriminative ability. 7,8 Nevertheless, its validation is restricted to developed countries, and it may not fully apply to low-and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

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Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study

et al. 2019

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Objective Intensive care unit (ICU) discharge is a decision process that is usually performed subjectively. We evaluated whether a subjective score (Sabadell score) is associated with hospital outcomes. Methods We conducted a prospective cohort study from August 2014 to May 2015 at a tertiary-care private hospital in Brazil. We analyzed 425 patients who were discharged alive from the ICU to the wards. We used univariate and multivariate analysis to identify risk factors associated with a composite endpoint of worse outcomes (later ICU readmission or ward death) during the same hospitalization. Results Forty-three patients (10.1%) were readmitted after ICU discharge, and 19 died in the ward. Compared with patients with successful outcomes, those with the composite endpoint were older and more severely ill, had a nonsurgical reason for hospitalization, more frequently came from the ward, were less frequently independent during daily activities, had sepsis, had higher C-reactive protein concentrations at ICU admission, and had higher Sabadell scores at discharge. The multivariate analysis showed that sepsis and the Sabadell score were independently and significantly associated with worse outcomes. Conclusion Sepsis at admission and the Sabadell score were predictors of worse hospital outcomes. The Sabadell score might be a promising predictive tool.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study

et al. 2019

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Clinician perception of long‐term survival at the point of critical care discharge: a prospective cohort study

Morton

Penston²,

McHale

et al. 2020

Anaesthesia

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Critical care survivors suffer persistent morbidity and increased risk of mortality as compared with the general population. Nevertheless, there are no standardised tools to identify at-risk patients. Our aim was to establish whether the Sabadell score, a simple tool applied by the treating clinician upon critical care discharge, was independently associated with 5-year mortality through a prospective observational cohort study of adults admitted to a general critical care unit. The Sabadell score, which is a measure of clinician-assigned survival perception, was applied to all patients from September 2011 to December 2017. The primary outcome was 5-year mortality, assessed using a multivariable flexible parametric survival analysis adjusted for baseline characteristics and clinically relevant covariates. We studied 5954 patients with a minimum of 18 months followup. Mean (SD) age was 59.5 (17.0) years and 3397 (57.1%) patients were men. We categorised 2287 (38.4%) patients as Sadabell 0; 2854 (47.9%) as Sadabell 1; 629 (10.5%) as Sadabell 2; and 183 (3.1%) as Sadabell 3. Adjusted hazard ratios for mortality were 2.1 (95%CI 1.9-2.4); 4.0 (95%CI 3.4-4.6); and 21.0 (95%CI 17.2-25.7), respectively. Sabadell 3 patients had 99.9%, 99.5%, 98.5% and 87.4% mortality at 5 years for patients in the age brackets ≥ 80, 60-79, 40-59 and 16-39 years, respectively. Sabadell 2 patients had 71.0%, 52.7%, 44.8% and 23.7% 5-year mortality for these same age categories. The Sabadell score was independently associated with 5year survival after critical care discharge. These findings can be used to guide provision of increased support for patients after critical care discharge and/or informed discussions with patients and relatives about dying to ascertain their future wishes.

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Death in hospital following ICU discharge: insights from the LUNG SAFE study

Madotto

McNicholas

Rezoagli

et al. 2020

Preprint

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Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. (Word count 251)Trial Registration: ClinicalTrials.gov NCT02010073

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Ward Mortality After ICU discharge: a Multicenter validation Of The Sabadell Score

Cited by 3 publications

References 0 publications

Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study

Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study

Clinician perception of long‐term survival at the point of critical care discharge: a prospective cohort study

Death in hospital following ICU discharge: insights from the LUNG SAFE study

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