PURPOSE:Patients readmitted to the hospital within 48 hours of prior discharge may require ICU care during readmission. Outcome data is limited for this unique population.
METHODS:Using ICU and hospital databases, we retrospectively studied patients from January 2004 to December 2006 who were admitted first to the ward within 48 hours of hospital discharge and then subsequently required ICU admission. Data collected included age, gender, diagnosis at hospital discharge, readmission and ICU admission, Mortality Probability Model (MPM) II score on ICU admission, use of mechanical ventilation (MV) or vasopressors during ICU stay, ICU and hospital lengths of stay (LOS) and mortality. Data are presented as means (±SD), absolute numbers and percentages.
RESULTS:Of 1,390 unique ICU admissions, 13 (0.9%) patients required ICU care during readmission. The majority of patients had lymphoma. Only 1 patient had been admitted to the ICU, for an unrelated reason, during the initial hospitalization. The mean age was 68.3 (±12.1) years, 61.5% were male, mean MPM II score was 44.4% (±20.9%). MV was required on 54% (7/13) and vasopressors on 54% (7/13). Pre-ICU LOS was 8.5 (±8.9) days, ICU LOS was 5.6 (±6.8) days and total hospital LOS was 24.7 (±24.9) days. ICU and hospital mortality was 38.5% and 53.8% respectively. A comparison of hospital discharge and readmission diagnoses revealed that 53.8% (7/13) were readmitted for problems related to the initial hospitalization. Five of these patients continued on to ICU admission because of further progression of the initial diagnosis. The other ICU admissions (8/13) were not related to the initial hospitalization.
CONCLUSION:In the majority of cases the reason for ICU admission was not related to the prior hospitalization. Regardless, in this unique population, both ICU and hospital mortality were markedly higher than historical data for our ICU (ICU mortality 20%, hospital mortality 35%).
CLINICAL IMPLICATIONS:Patients who require hospital readmission and subsequent ICU care are at very high risk of death.
DISCLOSURE:Madhu Ramaswmay, None.