Defining Physiological Decompensation: An Expert Consensus and Retrospective Outcome Validation.
Delphi study
cardiac arrest
mechanical ventilation
outcomes assessment
quality improvement
rapid response team
Journal
Critical care explorations
ISSN: 2639-8028
Titre abrégé: Crit Care Explor
Pays: United States
ID NLM: 101746347
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
entrez:
8
4
2022
pubmed:
9
4
2022
medline:
9
4
2022
Statut:
epublish
Résumé
Physiological decompensation of hospitalized patients is common and is associated with substantial morbidity and mortality. Research surrounding patient decompensation has been hampered by the absence of a robust definition of decompensation and lack of standardized clinical criteria with which to identify patients who have decompensated. We aimed to: 1) develop a consensus definition of physiological decompensation and 2) to develop clinical criteria to identify patients who have decompensated. We utilized a three-phase, modified electronic Delphi (eDelphi) process, followed by a discussion round to generate consensus on the definition of physiological decompensation and on criteria to identify decompensation. We then validated the criteria using a retrospective cohort study of adult patients admitted to the Hospital of the University of Pennsylvania. Quaternary academic medical center. Adult patients admitted to the Hospital of the University of Pennsylvania who had triggered a rapid response team (RRT) response between January 1, 2019, and December 31, 2020. None. Sixty-nine experts participated in the eDelphi. Participation was high across the three survey rounds (first round: 93%, second round: 94%, and third round: 98%). The expert panel arrived at a consensus definition of physiological decompensation, "An acute worsening of a patient's clinical status that poses a substantial increase to an individual's short-term risk of death or serious harm." Consensus was also reached on criteria for physiological decompensation. Invasive mechanical ventilation, severe hypoxemia, and use of vasopressor or inotrope medication were bundled as criteria for our novel decompensation metric: the adult inpatient decompensation event (AIDE). Patients who met greater than one AIDE criteria within 24 hours of an RRT call had increased adjusted odds of 7-day mortality (adjusted odds ratio [aOR], 4.1 [95% CI, 2.5-6.7]) and intensive care unit transfer (aOR, 20.6 [95% CI, 14.2-30.0]). Through the eDelphi process, we have reached a consensus definition of physiological decompensation and proposed clinical criteria with which to identify patients who have decompensated using data easily available from the electronic medical record, the AIDE criteria.
Identifiants
pubmed: 35392439
doi: 10.1097/CCE.0000000000000677
pmc: PMC8984412
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e0677Subventions
Organisme : AHRQ HHS
ID : K08 HS026975
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL131544
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007891
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL098054
Pays : United States
Informations de copyright
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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