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A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score
Rafael Fernandez1, Francisco Baigorri, Gema Navarro
1Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n, 08208, Sabadell, Spain. rfernandez@cspt.es
Introduction:
Mortality in the ward after an intensive care unit (ICU) stay is considered a quality parameter, and is described as a source of avoidable mortality. Additionally, the attending intensivist frequently anticipates fatal outcome after ICU discharge. Our objective was to test the ability of a new score to stratify patients according to ward mortality after ICU discharge.
Methods:
A prospective cohort study was performed in the general ICU of a university-affiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome.
Results:
We studied 1,521 patients with a mean age of 60.2 +/- 17.8 years. The median (25-75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. Post-ICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84-0.93) for the Sabadell score.
Conclusion:
The Sabadell score at ICU discharge works effectively to stratify patients according to hospital outcome.
Insights
The Sabadell score effectively predicts patient mortality after intensive care unit (ICU) discharge. This tool helps stratify patients, identifying those at higher risk for improved post-ICU care.
Area of Science:
- Critical Care Medicine
- Health Services Research
Background:
- Post-intensive care unit (ICU) ward mortality is a key quality indicator.
- Attending intensivists often predict fatal outcomes post-ICU discharge.
Purpose of the Study:
- To evaluate a novel scoring system for stratifying patients based on ward mortality risk after ICU discharge.
Main Methods:
- Prospective cohort study of 1,521 patients in a university-affiliated hospital.
- Recorded intensivist's subjective prognosis (Sabadell score) at ICU discharge.
- Compared prognosis with actual hospital outcomes.
Main Results:
- Ward mortality was 9.6% among 1,156 patients discharged from the ICU.
- Sabadell scores of 3 and 2 were associated with significantly higher mortality (81.3% and 41.1%, respectively).
- The Sabadell score demonstrated strong predictive ability (AUC 0.88).
Conclusions:
- The Sabadell score is an effective tool for stratifying hospital outcomes in patients post-ICU discharge.
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