Early prediction of new-onset physical disability after intensive care unit stay: a preliminary instrument

详细信息    查看全文

• 作者：Anna Schandl (1) (2)
  Matteo Bottai (3)
  Ulrika Holdar (1) (2)
  Elisabeth Hellgren (1) (2)
  Peter Sackey (1) (2)
  
  1. Department of Anesthesiology ; Surgical Services and Intensive Care Medicine ; Karolinska University Hospital Solna ; 17176 ; Stockholm ; Sweden
  2. The Institution of Physiology and Pharmacology ; Section for Anesthesiology and Intensive Care Medicine ; Karolinska Institutet ; 17177 ; Stockholm ; Sweden
  3. The Unit of Biostatistics ; Institute of Environmental Medicine ; Karolinska Institutet ; 17177 ; Stockholm ; Sweden
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：18
• 期：4
• 全文大小：357 KB
• 参考文献：1. Society of Critical Care Medicine: Critical Care Statistics. [http://www.sccm.org/Communications/Pages/CriticalCareStats.aspx]
  2. Schaaf, M, Beelen, A, Dongelmans, DA, Vroom, MB, Nollet, F (2009) Functional status after intensive care: a challenge for rehabilitation professionals to improve outcome. J Rehabil Med 41: pp. 360-366 CrossRef
  3. National Institute for Health and Clinical Excellence: Rehabilitation after critical illness. [http://guidance.nice.org.uk/CG83/NICEGuidance]
  4. Dowdy, DW, Eid, MP, Sedrakyan, A, Mendez-Tellez, PA, Pronovost, PJ, Herridge, MS, Needham, DM (2005) Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 31: pp. 611-620 CrossRef
  5. Svenska Intensivv氓rdsregistret - SIR: Riktlinje f枚r PostIVA uppf枚ljning. [http://www.icuregswe.org/sv/Riktlinjer/PostIVA-uppfoljning-20121/]
  6. Cuthbertson, BH, Rattray, J, Campbell, MK, Gager, M, Roughton, S, Smith, A, Hull, A, Breeman, S, Norrie, J, Jenkinson, D, Hern谩ndez, R, Johnston, M, Wilson, E, Waldmann, C (2009) The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ 339: pp. b3723 CrossRef
  7. Elliott, D, McKinley, S, Alison, J, Aitken, LM, King, M, Leslie, GD, Kenny, P, Taylor, P, Foley, R, Burmeister, E (2011) Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care 15: pp. R142 CrossRef
  8. Sackett, DL (2001) Why randomized controlled trials fail but needn't: 2. Failure to employ physiological statistics, or the only formula a clinician-trialist is ever likely to need (or understand!). CMAJ 165: pp. 1226-1237
  9. Herridge, MS (2011) The challenge of designing a post-critical illness rehabilitation intervention. Crit Care 15: pp. 1002 CrossRef
  10. Schandl, A, Bottai, M, Hellgren, E, Sundin, O, Sackey, P (2013) Developing an early screening instrument for predicting psychological morbidity after critical illness. Crit Care 17: pp. R210 CrossRef
  11. Steyerberg, EW (2009) Clinical Prediction Models. A practical approach to development, validation, and updating. Springer-Science鈥?鈥塀usiness Media, New York
  12. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40: pp. 373-383 CrossRef
  13. Ely, EW, Margolin, R, Francis, J, May, L, Truman, B, Dittus, R, Speroff, T, Gautam, S, Bernard, GR, Inouye, SK (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29: pp. 1370-1379 CrossRef
  14. Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA, Jaffe, MW (1963) Studies of Illness in the Aged: the index of Adl: a standardized measure of biological and psychosocial function. JAMA 185: pp. 914-919 CrossRef
  15. Sonn, U, Asberg, KH (1991) Assessment of activities of daily living in the elderly: a study of a population of 76-year-olds in Gothenburg, Sweden. Scand J Rehabil Med 23: pp. 193-202
  16. Efron, B, Tibshirani, R (1993) An introduction to the bootstrap. Chapman & Hall, New York CrossRef
  17. Ho, KM, Dobb, GJ, Knuiman, M, Finn, J, Webb, SA (2008) The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study. Med J Aust 189: pp. 26-30
  18. Isaacs, SL, Schroeder, SA (2004) Class - the ignored determinant of the nation's health. N Engl J Med 351: pp. 1137-1142 CrossRef
  19. Chaudhry, SI, Friedkin, RJ, Horwitz, RI, Inouye, SK (2004) Educational disadvantage impairs functional recovery after hospitalization in older persons. Am J Med 117: pp. 650-656 CrossRef
  20. Christensen, U, Schmidt, L, Hougaard, CO, Kriegbaum, M, Holstein, BE (2006) Socioeconomic position and variations in coping strategies in musculoskeletal pain: a cross-sectional study of 1,287 40- and 50-year-old men and women. J Rehabil Med 38: pp. 316-321 CrossRef
  21. Greenglass, ER, Marques, S, Ridder, M, Behl, S (2005) Positive coping and mastery in a rehabilitation setting. Int J Rehabil Res 28: pp. 331-339 CrossRef
  22. Willems, S, Maesschalck, S, Deveugele, M, Derese, A, Maeseneer, J (2005) Socio-economic status of the patient and doctor-patient communication: does it make a difference?. Patient Educ Couns 56: pp. 139-146 CrossRef
  23. Urquhart, DM, Williamson, OD, Gabbe, BJ, Cicuttini, FM, Cameron, PA, Richardson, MD, Edwards, ER (2006) Outcomes of patients with orthopaedic trauma admitted to level 1 trauma centres. ANZ J Surg 76: pp. 600-606 1445-2197.2006.03785.x" target="_blank" title="It opens in new window">CrossRef
  24. Livingston, DH, Tripp, T, Biggs, C, Lavery, RF (2009) A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit. J Trauma 67: pp. 341-348 CrossRef
  25. Schweickert, WD, Pohlman, MC, Pohlman, AS, Nigos, C, Pawlik, AJ, Esbrook, CL, Spears, L, Miller, M, Franczyk, M, Deprizio, D, Schmidt, GA, Bowman, A, Barr, R, McCallister, KE, Hall, JB, Kress, JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373: pp. 1874-1882 140-6736(09)60658-9" target="_blank" title="It opens in new window">CrossRef
  26. Schandl, AR, Brattstrom, OR, Svensson-Raskh, A, Hellgren, EM, Falkenhav, MD, Sackey, PV (2011) Screening and treatment of problems after intensive care: a descriptive study of multidisciplinary follow-up. Intensive Crit Care Nurs 27: pp. 94-101 CrossRef
  27. Covinsky, KE, Palmer, RM, Counsell, SR, Pine, ZM, Walter, LC, Chren, MM (2000) Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc 48: pp. 164-169
  28. Miller, EA, Weissert, WG (2000) Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Med Care Res Rev 57: pp. 259-297 CrossRef
  29. Schweickert, WD, Hall, J (2007) ICU-acquired weakness. Chest 131: pp. 1541-1549 CrossRef
  30. Mock, C, MacKenzie, E, Jurkovich, G, Burgess, A, Cushing, B, Lateur, B, McAndrew, M, Morris, J, Swiontkowski, M (2000) Determinants of disability after lower extremity fracture. J Trauma 49: pp. 1002-1011 CrossRef
  31. Letter, MA, Schmitz, PI, Visser, LH, Verheul, FA, Schellens, RL, Op de Coul, DA, Meche, FG (2001) Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med 29: pp. 2281-2286 CrossRef
  32. Nanas, S, Kritikos, K, Angelopoulos, E, Siafaka, A, Tsikriki, S, Poriazi, M, Kanaloupiti, D, Kontogeorgi, M, Pratikaki, M, Zervakis, D, Routsi, C, Roussos, C (2008) Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand 118: pp. 175-181 CrossRef
  33. Jonghe, B, Lacherade, JC, Sharshar, T, Outin, H (2009) Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med 37: pp. S309-S315 CrossRef
  34. Thomason, JW, Shintani, A, Peterson, JF, Pun, BT, Jackson, JC, Ely, EW (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9: pp. R375-R381 CrossRef
  35. Holbrook, TL, Anderson, JP, Sieber, WJ, Browner, D, Hoyt, DB (1999) Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project. J Trauma 46: pp. 765-771 CrossRef
  36. Latronico, N, Bolton, CF (2011) Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol 10: pp. 931-941 1474-4422(11)70178-8" target="_blank" title="It opens in new window">CrossRef
  37. Stevens, RD, Dowdy, DW, Michaels, RK, Mendez-Tellez, PA, Pronovost, PJ, Needham, DM (2007) Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 33: pp. 1876-1891 CrossRef
  
• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Many intensive care unit (ICU) survivors suffer from physical disability for months after ICU stay. There is no structured method to identify patients at risk for such problems. The purpose of the study was to develop a method for early in-ICU prediction of the patient鈥檚 individual risk for new-onset physical disability two months after ICU stay. Methods In total, 23 potential predictors for physical disability were assessed before individual ICU discharge. Two months after ICU discharge, out of 232 eligible patients, 148 ICU survivors (64%) completed the activity of daily living (ADL) staircase questionnaire to determine new-onset physical disability. Results A total of 95% percent of patients had no ADL reduction prior to ICU admission. Forty-seven percent (n鈥?鈥?9) of questionnaire responders suffered from worsened ADL. We identified four independent predictors for new-onset physical disability: Low educational level (odds ratio (OR)鈥?鈥?.8), impaired core stability (OR鈥?鈥?.6), fractures (OR鈥?鈥?.5) and ICU length of stay longer than two days (OR鈥?鈥?.6). The predictors were included in a screening instrument. The regression coefficient of each predictor was transformed into a risk score. The sum of risk scores was related to a predicted probability for physical disability in the individual patient. The cross-validated area under receiver operating characteristics curve (AUC) for the screening instrument was 0.80. Conclusions Educational level is the single most important predictor for new-onset physical disability two months after ICU stay, followed by impaired core stability at ICU discharge, the presence of fractures and ICU stay longer than two days. A simple screening instrument based on these predictors can be used at ICU discharge to determine the risk for new-onset physical disability. This preliminary instrument may help clinicians to identify patients in need of support, but needs external validation prior to wider clinical use.