Evaluation of the physiological variables and scoring systems at intensive care discharge as predictors of clinical deterioration and readmission: a single-centre retrospective study.

Abstract

We aim to determine, using routinely collected data and common scoring systems, whether parameters seen at intensive care unit (ICU) discharge can be predictive of subsequent clinical deterioration. A single-centre retrospective study located in a tertiary hospital in the south of England. 1868 patients who were admitted and discharged from ICU between 1 April 2023 and 31 March 2024 were screened for eligibility. A total of 1393 patients were included in the final analysis, including 122 patients who were classified in the 'deteriorated' subgroup. Assessment of vital signs, blood markers of infection and inflammation and three scoring systems (National Early Warning Score 2 (NEWS2), Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment (SOFA) score) taken within 24 hours prior to ICU discharge. Assessment of predictors of deterioration after ICU discharge. Reasons for readmission to ICU, hospital mortality, ICU length of stay and time before readmission to ICU. Heart rate, conscious level (alert, voice, pain, unresponsive scale) and SOFA score were independent predictors of deterioration after ICU discharge (under the curve 0.85, CI 0.79 to 0.90, specificity 82.3%, sensitivity 79.7%) in multivariable models. Of these, a reduced level of consciousness was the most significant predictor of clinical deterioration (OR 19.6, CI 11.4 to 35.0). NEWS2 was an independent predictor for deterioration on univariable analysis. Mortality was significantly increased in patients who experienced deterioration after ICU discharge, as was ICU length of stay. Predictive models may be useful in assisting clinicians with ICU discharge decisions. Further research is required to develop patient-tailored scoring systems that incorporate other factors that are needed for decisions around ICU discharge.