Severity of illness and risk of readmission to intensive care: A meta-analysis

Frost, SA; Alexandrou, E; Bogdanovski, T; Salamonson, Y; Davidson, PM; Parr, MJ; Hillman, KM

Severity of illness and risk of readmission to intensive care: A meta-analysis

Frost, SA Alexandrou, E Bogdanovski, T Salamonson, Y Davidson, PM

Parr, MJ Hillman, KM

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Publication Type:: Journal Article
Citation:: Resuscitation, 2009, 80 (5), pp. 505 - 510
Issue Date:: 2009-05-01

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Field	Value	Language
dc.contributor.author	Frost, SA	en_US
dc.contributor.author	Alexandrou, E	en_US
dc.contributor.author	Bogdanovski, T	en_US
dc.contributor.author	Salamonson, Y	en_US
dc.contributor.author	Davidson, PM https://orcid.org/0000-0003-2050-1534	en_US
dc.contributor.author	Parr, MJ	en_US
dc.contributor.author	Hillman, KM	en_US
dc.date.available	2009-02-19	en_US
dc.date.issued	2009-05-01	en_US
dc.identifier.citation	Resuscitation, 2009, 80 (5), pp. 505 - 510	en_US
dc.identifier.issn	0300-9572	en_US
dc.identifier.uri	http://hdl.handle.net/10453/15632
dc.description.abstract	Background: Almost one in every 10 patients who survive intensive care will be readmitted to the intensive care unit (ICU) during the same hospitalisation. The association between increasing severity of illness (widely calculated in ICU patients) with risk of readmission to ICU has not been systematically summarized. Objective: The meta-analysis was designed to combine information from published studies to assess the relationship between severity of illness in ICU patients and the risk of readmission to ICU during the same hospitalisation. Data sources: Studies were identified by searching MEDLINE (1966 to August 2008), EMBASE (1980-2008), and CINAHL (1982 to August 2008). Review methods: Studies included only adult populations, readmissions to ICU during the same hospitalisation and reports of valid severity of illness index. Results: Eleven studies (totaling 220 000 patients) were included in the meta-analysis. Severity of illness (APACHE II, APACHE III, SAPS and SAPS II) measured at the time of ICU admission or discharge, was higher in patients readmitted to the ICU during the same hospitalisation compared to patients not-readmitted (both p-values < 0.001). The risk of readmission to ICU increased by 43% with each standard deviation increase in severity of illness score (regardless if measured on admission to, or discharge from the ICU) (odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.3-1.6). Conclusions: A relationship between increasing intensive care severity of illness and risk of readmission to ICU was found. The effect was the same regardless of the time of measurement of severity of illness (at admission to ICU or the time of discharge from ICU). However, further research is required to develop more comprehensive tools to identify patients at risk of readmission to ICU to allow the targeted interventions, such as ICU-outreach to follow-up these patients to minimize adverse events. © 2009 Elsevier Ireland Ltd. All rights reserved.	en_US
dc.relation.ispartof	Resuscitation	en_US
dc.relation.isbasedon	10.1016/j.resuscitation.2009.02.015	en_US
dc.subject.classification	Emergency & Critical Care Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Critical Illness	en_US
dc.subject.mesh	Intensive Care	en_US
dc.subject.mesh	Patient Readmission	en_US
dc.subject.mesh	APACHE	en_US
dc.subject.mesh	Severity of Illness Index	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Intensive Care Units	en_US
dc.subject.mesh	Critical Care	en_US
dc.title	Severity of illness and risk of readmission to intensive care: A meta-analysis	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	80	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	80	en_US

Abstract:

Background: Almost one in every 10 patients who survive intensive care will be readmitted to the intensive care unit (ICU) during the same hospitalisation. The association between increasing severity of illness (widely calculated in ICU patients) with risk of readmission to ICU has not been systematically summarized. Objective: The meta-analysis was designed to combine information from published studies to assess the relationship between severity of illness in ICU patients and the risk of readmission to ICU during the same hospitalisation. Data sources: Studies were identified by searching MEDLINE (1966 to August 2008), EMBASE (1980-2008), and CINAHL (1982 to August 2008). Review methods: Studies included only adult populations, readmissions to ICU during the same hospitalisation and reports of valid severity of illness index. Results: Eleven studies (totaling 220 000 patients) were included in the meta-analysis. Severity of illness (APACHE II, APACHE III, SAPS and SAPS II) measured at the time of ICU admission or discharge, was higher in patients readmitted to the ICU during the same hospitalisation compared to patients not-readmitted (both p-values < 0.001). The risk of readmission to ICU increased by 43% with each standard deviation increase in severity of illness score (regardless if measured on admission to, or discharge from the ICU) (odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.3-1.6). Conclusions: A relationship between increasing intensive care severity of illness and risk of readmission to ICU was found. The effect was the same regardless of the time of measurement of severity of illness (at admission to ICU or the time of discharge from ICU). However, further research is required to develop more comprehensive tools to identify patients at risk of readmission to ICU to allow the targeted interventions, such as ICU-outreach to follow-up these patients to minimize adverse events. © 2009 Elsevier Ireland Ltd. All rights reserved.

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http://hdl.handle.net/10453/15632