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ICU discharge screening for prediction of new-onset physical disability: A multinational cohort study
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2020 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new‐onset physical disability at ICU discharge.

Methods: Multinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new‐onset physical disability 3 months post‐ICU, defined as a ≥10 score reduction in the Barthel Index (BI) compared to baseline.

Results: Of the 572 included patients, follow‐up data are available on 78% of patients alive at follow‐up. The incidence of new‐onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81‐0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61‐0.76). Negative predictive value for a low‐risk group (CPAx score >18) was 0.88, and positive predictive value for a high‐risk group (CPAx score ≤18) was 0.32.

Conclusion: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post‐ICU. For high‐risk patients, research to determine post‐ICU risk factors for an incomplete rehabilitation is mandated.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2020.
Keywords [en]
activities of daily living, complications, critical care, decision support techniques, intensive care unit, rehabilitation
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-169116DOI: 10.1111/aas.13563ISI: 000516886000001PubMedID: 32083323OAI: oai:DiVA.org:umu-169116DiVA, id: diva2:1416557
Available from: 2020-03-24 Created: 2020-03-24 Last updated: 2020-03-24

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Brorsson, Camilla

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Joelsson-Alm, EvaBrorsson, Camilla
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