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Using a real-time ABCDEF compliance tool to understand the role of bundle elements in mortality and delirium
Jackson C Shampo1, Kenneth Wenszell, Xian Luo-Owen
1From the Loma Linda University School of Medicine (J.C.S.); Loma Linda University Medical Center (K.W., N.M., S.M.) and Division of Acute Care Surgery (X.L.-O., M.C.-Y., S.K.B., K.M.), Loma Linda University Medical Center, Loma Linda; Division of Trauma, Burns, Critical Care, and Acute Care Surgery (L.S.), University of California Irvine Health, Irvine; Department of Trauma, Critical Care, and General Surgery (D.T.), Mayo Clinic, Rochester, Minnesota; and Critical Care Center, Department of Anesthesiology (I.R.D.), Loma Linda University Medical Center, Loma Linda, California.
Insights
The maximum daily ABC-123 score and improved mobility in critically injured patients are linked to lower mortality and reduced delirium. Mobility significantly decreases death risk, while specific ABC-123 subscores impact outcomes.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Health Informatics
Background:
- The ABCDEF bundle is crucial for managing critically ill patients, but compliance assessment can be challenging.
- A novel electronic medical record score, ABC-123, was developed to quantify adherence to the ABCDEF bundle.
- This study investigates the association between the ABC-123 score, mobility, and patient outcomes in critically injured individuals.
Approach:
- A retrospective analysis of 172 critically injured patients over six months was conducted.
- Data included demographics, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) for head, and various clinical variables.
- Logistic regression models assessed the impact of ABC-123 scores and mobility on hospital mortality and delirium-free/coma-free intensive care unit (DF/CF-ICU) days.
Key Points:
- Higher maximum daily ABC-123 scores and improved mobility were associated with decreased mortality.
- Mobility improvement during hospitalization significantly reduced mortality odds by 83%.
- Restraint use was linked to a >70% reduction in the odds of DF/CF-ICU days.
Conclusions:
- The maximum daily ABC-123 score is a valuable tool for predicting outcomes in critically injured patients.
- Mobility is a powerful factor in reducing mortality, highlighting its therapeutic importance.
- Specific ABC-123 subscores (B and D) demonstrated the strongest positive association with improved outcomes regarding mortality and delirium.
Background:
ABC-123, a novel Epic electronic medical record real-time score, assigns 0 to 3 points per bundle element to assess ABCDEF bundle compliance. We sought to determine if maximum daily ABC-123 score (ABC-MAX), individual bundle elements, and mobility were associated with mortality and delirium-free/coma-free intensive care unit (DF/CF-ICU) days in critically injured patients.
Methods:
We reviewed 6 months of single-center data (demographics, Injury Severity Score [ISS], Abbreviated Injury Scale of the head [AIS-Head] score, ventilator and restraint use, Richmond Agitation Sedation Score, Confusion Assessment Method for the ICU, ABC-MAX, ABC-123 subscores, and mobility level). Hospital mortality and likelihood of DF/CF-ICU days were endpoints for logistic regression with ISS, AIS-Head, surgery, penetrating trauma, sex, age, restraint and ventilator use, ABC-MAX or individual ABC-123 subscores, and mobility level or a binary variable representing any improvement in mobility during admission.
Results:
We reviewed 172 patients (69.8% male; 16.3% penetrating; median age, 50.0 years [IQR, 32.0-64.8 years]; ISS, 17.0 [11.0-26.0]; AIS-Head, 2.0 [0.0-3.0]). Of all patients, 66.9% had delirium, 48.8% were restrained, 51.7% were ventilated, and 11.0% died. Age, ISS, AIS-Head, and penetrating mechanism were associated with increased mortality. Restraints were associated with more than 70% reduction in odds of DF/CF-ICU days. Maximum daily ABC-123 score and mobility level were associated with decreased odds of death and increased odds of DF/CF-ICU days. Any improvement in mobility during hospitalization was associated with an 83% reduction in mortality odds. A and C subscores were associated with increased mortality, and A was also associated with decreased DF/CF-ICU days. B and D subscores were associated with increased DF/CF-ICU days. D and E subscores were associated with decreased mortality.
Conclusion:
Maximum daily ABC-123 score is associated with reduced mortality and delirium in critically injured patients, while mobility is associated with dramatic reduction in mortality. B and D subscores have the strongest positive effects on both mortality and delirium.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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