Utilization of an ICU Severity of Illness Scoring System to Triage Patients With ST-Elevation Myocardial Infarction
Jonathan M Norton1, Prathibha K Reddy1, Keshab Subedi1
122496Christiana Care Health System, Newark, DE, USA.
Insights
A new subjective scoring system can identify low-risk ST-elevation myocardial infarction (STEMI) patients, allowing them to bypass the intensive care unit (ICU) for intermediate care.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Many ST-elevation myocardial infarction (STEMI) patients are admitted to the intensive care unit (ICU) but do not require such a high level of care.
- A need exists to identify low-risk STEMI patients for appropriate care allocation.
Purpose of the Study:
- To develop and validate a subjective scoring system to identify low-risk STEMI patients.
- To enable safe triage of these patients to an intermediate level of care, avoiding unnecessary ICU admission.
Main Methods:
- Retrospective observational study using data from the ACTION Registry and CathPCI Registry.
- Analysis of Acute Physiology and Chronic Health Evaluation (APACHE) III scores and subjective criteria for STEMI patients.
- Evaluation of complications, length of stay, and in-hospital mortality.
Main Results:
- Out of 253 STEMI patients, 70.75% were classified as low-risk and suitable for intermediate care.
- High-risk patients (29.25%) required ICU admission.
- A significant difference in APACHE III scores was observed between low-risk and high-risk groups (P < .001).
Conclusions:
- Subjective criteria can effectively identify low-risk STEMI patients.
- Low-risk patients identified by these criteria have low APACHE III scores and minimal risk of complications.
- Triage to intermediate care is a viable option for selected low-risk STEMI patients, optimizing resource utilization.
Objective:
To subjectively identify low-risk ST-elevation myocardial infarction (STEMI) patients and triage this low-risk population to an intermediate level of care.
Background:
Many patients with STEMI are admitted to the intensive care unit (ICU), however, a large portion do not merit ICU admission. We sought to examine whether, among post-STEMI patients admitted to the ICU, if an easily obtainable subjective scoring system could predict low-risk patients and safely triage them to an intermediate level of care.
Methods:
Retrospective observational study at Christiana Hospital, a 900-bed regional referral center. Data were defined by the ACTION Registry and CathPCI Registry. Acute Physiology and Chronic Health Evaluation (APACHE) predictions were retrieved for all patients with STEMI and were analyzed for complications, length of stay, and inhospital mortality. We then examined subjective criteria to triage patients with STEMI out of the ICU.
Results:
Among 253 patients with STEMI, 179 (70.75%) were classified as low risk (intermediate level care appropriate) and 74 (29.25%) were classified as high risk (ICU appropriate). The mean age was 64.95 years. The APACHE III score was right skewed with a mean of 36.97 and a median of 31. There was a significant difference between the APACHE III score of low-risk patients and the APACHE III score of high-risk patients (P < .001).
Conclusion:
In conclusion, patients characterized as low risk, as defined by our criteria, had low APACHE III scores and a low likelihood of complications post-STEMI. This low-risk population could potentially be admitted to an intermediate level of care, avoiding the ICU altogether.
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