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Critical Care: Critical Care |

Rothman Index as a Predictor of Post-Discharge Adverse Events in a Medical Intensive Care Unit FREE TO VIEW

Deepa Gotur, MD; Janice Zimmerman, MD
Author and Funding Information

Houston Methodist Hospital, Houston, TX


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A149. doi:10.1016/j.chest.2016.02.155
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Published online

SESSION TITLE: Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM

PURPOSE: The Rothman Index (RI) is an acuity metric that incorporates 26 variables of physiological measures, clinical assessments and laboratory results into a composite index that is trended over time. If the RI drops more than 30% in <6 hours, 50% in <24 hours or an absolute value <20 in the previous 24 hours, a warning sign graded as medium, high or very high risk respectively, alerts the clinician. As part of a quality improvement project, our objectives were- 1. Determine if RI could predict adverse events occurring within 72 hours of medical intensive care unit (MICU) discharge decision 2. Find a cut point for the RI that can predict adverse events 3. Determine if there is a relation between warning sign 24 hours prior to discharge and adverse events post-discharge.

METHODS: A single-center prospective cohort observational study included patients discharged from the MICU between 1/20/2015 to 3/14/2015. Data encompassing RI at the time of decision-making for MICU discharge and presence of any warning sign in the prior 24 hours was collected. A 72-hour follow-up chart review recorded adverse events that included readmissions, discontinuation of MICU discharge orders due to clinical status change, emergency department visit if discharged home from MICU, rapid response activation and cardiopulmonary arrest. A logistic regression model was used to predict probability of adverse events. Chi-Square test was used to assess the difference in proportion between RI score category and adverse event for several RI cut-off values. Chi-Square test was also used to test the association between RI warning and adverse events.

RESULTS: A total of 219 patients (50.68% males) were studied with a median age of 65 years (IQR 53-80). The RI at the time of discharge decision was 53.7 (IQR 36.35-68.2). Adverse events were observed in 31 patients (14.15%). A higher RI was associated with lower odds of an adverse event (OR = 0.966, p=0.001). A RI value >50 was associated with 67% lower odds of an adverse event (OR = 0.335, 95% CI =0.1522, 0.7388, p=0.0067) compared to RI <50. This RI value was associated with the largest decrease in odds of events. Patients with a very high-risk warning sign had a higher proportion of adverse events compared to patients that did not (33.33% vs. 12.65%, p=<0.02).

CONCLUSIONS: Patients who have a RI <50 or a very high-risk warning alert have a higher risk of adverse events post-discharge from the MICU.

CLINICAL IMPLICATIONS: The RI is a helpful adjunct to clinical judgement for decision-making for MICU discharges.

DISCLOSURE: The following authors have nothing to disclose: Deepa Gotur, Janice Zimmerman

No Product/Research Disclosure Information


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