Ome of patients requiring intensive care readmissionN Conlon, B Vaborbactam O’Brien, B Marsh Mater Misericordiae University Hospital, Dublin, Ireland Critical Care 2007, 11(Suppl 2):P477 (doi: 10.1186/cc5637) Introduction Rates of readmission to the ICU are often cited as controversial indices of quality of intensive care, adequacy of follow-up and as guides to resource allocation. Nonetheless there are few data on the long-term functional outcome of ICU recidivists: we set out to study this.SCritical CareMarch 2007 Vol 11 Suppl27th International Symposium on Intensive Care and Emergency MedicineMethods With ethical approval, from a prospectively collected database of all ICU admissions from 2004, we identified all readmissions to our ICU from within the hospital. We identified survivors from the database, and contacted them, 2? years later, to assess their functional outcome, as the Glasgow Outcome Score (GOS) and Karnofsky score. Results Of 97 readmissions, 79 (81 ) survived the ICU. Most of PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20799856 them (57 ) came from the high-dependency unit (HDU), of whom 74 survived. Thirty-three per cent came from other wards and 10 from theatre: 90 of each of these groups survived the ICU. Further data on these groups’ interim survival and functional outcomes are presented. Conclusion Survival rates among those readmitted are high. Those returning from the HDU represent a cohort at higher risk of mortality. The functional status after 2.5 years varies particularly with the timing of readmission, readmission diagnosis and APACHE score at readmission.60.6 , n = 109, P > 0.5). Mortality (deaths/30 days) varied dramatically between the early, middle and late phases (29.1 vs 3.2 vs 0.9 , P < 0.001). Conclusions Although mortality is high during the first 30 days of neurological critical illness there is a significant plateau in the survival curve; patients surviving beyond the initial phase tend to survive long term. Larger studies may be beneficial to further evaluate subgroup variation in the survival curve profile.P479 Use of a modified early warning system to predict outcome in patients admitted to a high dependency unitC Carle, C Pritchard, S Northey, J Paddle Royal Cornwall Hospital, Truro, UK Critical Care 2007, 11(Suppl 2):P479 (doi: 10.1186/cc5639) Introduction The modified early warning system (MEWS) is a physiological scoring system that identifies patients at risk of deterioration who require increased levels of care [1]. The use of a patient's MEWS score to predict outcome in a high-dependency unit (HDU) has not been previously described. Method Approval for the study was granted by the local ethics committee. We reviewed MEWS scores from all patients (n = 2,974) admitted to a six-bed medical and surgical adult HDU in a general hospital from July 2002 to October 2005. The MEWS score was calculated from observations of heart rate, blood pressure, respiratory rate, urine output, conscious level and temperature recorded within 24 hours of admission to the HDU. Results Of the 2,974 patients reviewed, 2,447 patients had sufficient data. Analysis using logistic regression shows a strong relationship between the probability of death and the MEWS score: the odds of death increase by 1.48 (confidence interval 1.41?.56; P < 0.001) for each unit increase in the MEWS score. However, there is no reason that these data should follow a logistic form and the estimates of uncertainty around the point estimates from logistic regression are poor. More accurate estimates.
