Prognostic factors of patients admitted in a medical intermediate care unit: a prospective observational study

Authors

  • Liliana Fernandes
  • Sofia Duque
  • Joana Silvestre
  • Patrícia Freitas
  • Marta Pinto Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.
  • Alice Sousa Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.
  • Vitor Batalha Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.
  • Luís Campos Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.

DOI:

https://doi.org/10.3823/1762

Keywords:

Keywords, medical intermediate care unit, mortality, prognostic factors, acute illness severity, nurse workload, comorbidity, functional status

Abstract

Background

Medical Intermediate Care Units (IntCU’s) are high-dependency units intended for treatment of patients who do not meet criteria for admission to intensive care units (ICU’s) but require a higher level of care than can be provided in general ward. IntCU’s operate as a transitional unit, improving patients outcome. In addition, IntCU’s permit better resource utilization, reducing the length of stay in ICU and therefore increasing availability of critical care. Regardless of admission of unstable patients in IntCU’s, studies on prognostic factors are scarce. Our purpose was to identify prognostic factors of patients admitted in IntCU.

Methods

A prospective observational study was performed during 32 months in a IntCU of a central hospital. Main objective was evaluation of mortality and analysis of acute illness severity, nurse workload, comorbidity and previous functional status as prognostic factors. Assessment of these variables was performed using several standardized scores: Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System-28 (TISS-28), Nursing Activities Score (NAS), Charlson comorbidity index and Barthel index of basic activities of daily living. Bivariate and multiple logistic regression with forwards stepwise selection were used to identify prognostic factors of IntCU and in-hospital mortality.

Results

Two hundred and eighty-eight patients were included, mean age 65,67 ± 20,38 years-old. IntCU and in-hospital mortality was 9,38 and 17,71%, respectively. All the scores applied, concerning comorbidity, functional status, acute illness severity and nurse workload were good predictors of mortality. SAPS II was the better predictor of mortality followed by NAS.

Conclusions

Acute illness severity and nursing workload scores validated in ICU are useful and reliable in IntCU setting, being SAPS II and NAS the strongest predictors of mortality. Comorbidity, functional status and age were also prognostic factors. Consequently, a comprehensive assessment of patients admitted in IntCU is mandatory to reliably predict outcome. Several scores might be used to help clinical judgment, concerning admission criteria and clinical decisions.

 

 

Author Biographies

Liliana Fernandes

Internal Medicine Specialist, Medicine Department, Internal Medicine Service, Beatriz Ângelo Hospital, Portugal

Sofia Duque

Intensivist, Polivalent Intensive Care Unit, São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Lisbon, Portugal

Joana Silvestre

Internal Medicine Specialist, Urgency Department, Fernando Fonseca Hospital, Portugal.

Patrícia Freitas

Internal Medicine Resident, Medicine Department 4,Internal Medicine Service, São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Lisbon, Portugal

Marta Pinto, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.

Oncology Resident, Oncology Service, São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Lisbon, Portugal

Alice Sousa, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.

Internal Medicine Specialist, Medicine Department 4,Internal Medicine Service, São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Lisbon, Portugal

Vitor Batalha, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.

Internal Medicine Senior Specialist, Director,Medical Intermediate Care Unit, Medicine Department 4, São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Lisbon, Portugal

Luís Campos, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental.

Internal Medicine Senior Specialist, Director, Internal Medicine Service, São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Lisbon, Portugal

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Published

2015-07-30

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Internal Medicine & Hospital Medicine

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