Application of electronic medical record-derived analytics in critical care

Rothman Index predicts mortality and readmissions in surgical intensive care unit patients

Abdul Q. Alarhayem, Mark T. Muir, Donald J. Jenkins, Basil A Pruitt, Brian J Eastridge, Maulik P. Purohit, Ramon F. Cestero

Research output: Contribution to journalArticle

Abstract

INTRODUCTION The Rothman Index (RI) is an objective measurement of a patient's overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality. METHODS We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016. Data included demographics, length of stay (LOS), mortality, and RI at multiple pretransfer and post-transfer time points. RESULTS A total of 1,445 SICU patients were transferred to the surgical floor; 79 patients (5.5%) were readmitted within 48 hours of transfer. Mean age was 52 years, and 67% were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs. 11 days, p < 0.05) as well as higher mortality (2.5% vs. 0.6%, p < 0.05). Patients requiring readmission also had a lower RI at 72, 48, and 24 hours before transfer as well as at 24 and 48 hours after transfer (p < 0.05 for all). Rothman Index scores were categorized into higher-risk (<40), medium-risk (40-65), and lower-risk groups (>65); RI scores at 24 hours before transfer were inversely proportional to overall mortality (RI < 40 = 2.5%, RI 40-65 = 0.3%, and RI > 65 = 0%; p < 0.05) and SICU readmission rates (RI < 40 = 9%, RI 40-65 = 5.2%, and RI > 65 = 2.8%; p < 0.05). Patients transferred with RI scores greater than 83 did not require SICU readmission within 48 hours. CONCLUSION Surgical ICU patients requiring readmission within 48 hours of transfer have a significantly higher mortality and longer LOS compared to those who do not. Patients requiring readmission also have significantly lower pretransfer and post-transfer RI scores compared to those who do not. Rothman Index scores may be used as a clinical tool for evaluating patients before transfer from the SICU. Prospective studies are warranted to further validate use of this technology. LEVEL OF EVIDENCE Retrospective database review, level III.

Original languageEnglish (US)
Pages (from-to)635-641
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Electronic Health Records
Critical Care
Intensive Care Units
Mortality
Patient Readmission
Length of Stay
Cardiovascular Nursing
Nursing Assessment
Patient Transfer
Vital Signs
Demography
Databases
Prospective Studies
Technology

Keywords

  • predicting ICU readmission
  • Rothman Index
  • surgical ICU

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Application of electronic medical record-derived analytics in critical care : Rothman Index predicts mortality and readmissions in surgical intensive care unit patients. / Alarhayem, Abdul Q.; Muir, Mark T.; Jenkins, Donald J.; Pruitt, Basil A; Eastridge, Brian J; Purohit, Maulik P.; Cestero, Ramon F.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 4, 01.04.2019, p. 635-641.

Research output: Contribution to journalArticle

Alarhayem, Abdul Q. ; Muir, Mark T. ; Jenkins, Donald J. ; Pruitt, Basil A ; Eastridge, Brian J ; Purohit, Maulik P. ; Cestero, Ramon F. / Application of electronic medical record-derived analytics in critical care : Rothman Index predicts mortality and readmissions in surgical intensive care unit patients. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 4. pp. 635-641.
@article{00617e45b16e45e2bffd09a74041b89f,
title = "Application of electronic medical record-derived analytics in critical care: Rothman Index predicts mortality and readmissions in surgical intensive care unit patients",
abstract = "INTRODUCTION The Rothman Index (RI) is an objective measurement of a patient's overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality. METHODS We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016. Data included demographics, length of stay (LOS), mortality, and RI at multiple pretransfer and post-transfer time points. RESULTS A total of 1,445 SICU patients were transferred to the surgical floor; 79 patients (5.5{\%}) were readmitted within 48 hours of transfer. Mean age was 52 years, and 67{\%} were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs. 11 days, p < 0.05) as well as higher mortality (2.5{\%} vs. 0.6{\%}, p < 0.05). Patients requiring readmission also had a lower RI at 72, 48, and 24 hours before transfer as well as at 24 and 48 hours after transfer (p < 0.05 for all). Rothman Index scores were categorized into higher-risk (<40), medium-risk (40-65), and lower-risk groups (>65); RI scores at 24 hours before transfer were inversely proportional to overall mortality (RI < 40 = 2.5{\%}, RI 40-65 = 0.3{\%}, and RI > 65 = 0{\%}; p < 0.05) and SICU readmission rates (RI < 40 = 9{\%}, RI 40-65 = 5.2{\%}, and RI > 65 = 2.8{\%}; p < 0.05). Patients transferred with RI scores greater than 83 did not require SICU readmission within 48 hours. CONCLUSION Surgical ICU patients requiring readmission within 48 hours of transfer have a significantly higher mortality and longer LOS compared to those who do not. Patients requiring readmission also have significantly lower pretransfer and post-transfer RI scores compared to those who do not. Rothman Index scores may be used as a clinical tool for evaluating patients before transfer from the SICU. Prospective studies are warranted to further validate use of this technology. LEVEL OF EVIDENCE Retrospective database review, level III.",
keywords = "predicting ICU readmission, Rothman Index, surgical ICU",
author = "Alarhayem, {Abdul Q.} and Muir, {Mark T.} and Jenkins, {Donald J.} and Pruitt, {Basil A} and Eastridge, {Brian J} and Purohit, {Maulik P.} and Cestero, {Ramon F.}",
year = "2019",
month = "4",
day = "1",
doi = "10.1097/TA.0000000000002191",
language = "English (US)",
volume = "86",
pages = "635--641",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Application of electronic medical record-derived analytics in critical care

T2 - Rothman Index predicts mortality and readmissions in surgical intensive care unit patients

AU - Alarhayem, Abdul Q.

AU - Muir, Mark T.

AU - Jenkins, Donald J.

AU - Pruitt, Basil A

AU - Eastridge, Brian J

AU - Purohit, Maulik P.

AU - Cestero, Ramon F.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - INTRODUCTION The Rothman Index (RI) is an objective measurement of a patient's overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality. METHODS We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016. Data included demographics, length of stay (LOS), mortality, and RI at multiple pretransfer and post-transfer time points. RESULTS A total of 1,445 SICU patients were transferred to the surgical floor; 79 patients (5.5%) were readmitted within 48 hours of transfer. Mean age was 52 years, and 67% were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs. 11 days, p < 0.05) as well as higher mortality (2.5% vs. 0.6%, p < 0.05). Patients requiring readmission also had a lower RI at 72, 48, and 24 hours before transfer as well as at 24 and 48 hours after transfer (p < 0.05 for all). Rothman Index scores were categorized into higher-risk (<40), medium-risk (40-65), and lower-risk groups (>65); RI scores at 24 hours before transfer were inversely proportional to overall mortality (RI < 40 = 2.5%, RI 40-65 = 0.3%, and RI > 65 = 0%; p < 0.05) and SICU readmission rates (RI < 40 = 9%, RI 40-65 = 5.2%, and RI > 65 = 2.8%; p < 0.05). Patients transferred with RI scores greater than 83 did not require SICU readmission within 48 hours. CONCLUSION Surgical ICU patients requiring readmission within 48 hours of transfer have a significantly higher mortality and longer LOS compared to those who do not. Patients requiring readmission also have significantly lower pretransfer and post-transfer RI scores compared to those who do not. Rothman Index scores may be used as a clinical tool for evaluating patients before transfer from the SICU. Prospective studies are warranted to further validate use of this technology. LEVEL OF EVIDENCE Retrospective database review, level III.

AB - INTRODUCTION The Rothman Index (RI) is an objective measurement of a patient's overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality. METHODS We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016. Data included demographics, length of stay (LOS), mortality, and RI at multiple pretransfer and post-transfer time points. RESULTS A total of 1,445 SICU patients were transferred to the surgical floor; 79 patients (5.5%) were readmitted within 48 hours of transfer. Mean age was 52 years, and 67% were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs. 11 days, p < 0.05) as well as higher mortality (2.5% vs. 0.6%, p < 0.05). Patients requiring readmission also had a lower RI at 72, 48, and 24 hours before transfer as well as at 24 and 48 hours after transfer (p < 0.05 for all). Rothman Index scores were categorized into higher-risk (<40), medium-risk (40-65), and lower-risk groups (>65); RI scores at 24 hours before transfer were inversely proportional to overall mortality (RI < 40 = 2.5%, RI 40-65 = 0.3%, and RI > 65 = 0%; p < 0.05) and SICU readmission rates (RI < 40 = 9%, RI 40-65 = 5.2%, and RI > 65 = 2.8%; p < 0.05). Patients transferred with RI scores greater than 83 did not require SICU readmission within 48 hours. CONCLUSION Surgical ICU patients requiring readmission within 48 hours of transfer have a significantly higher mortality and longer LOS compared to those who do not. Patients requiring readmission also have significantly lower pretransfer and post-transfer RI scores compared to those who do not. Rothman Index scores may be used as a clinical tool for evaluating patients before transfer from the SICU. Prospective studies are warranted to further validate use of this technology. LEVEL OF EVIDENCE Retrospective database review, level III.

KW - predicting ICU readmission

KW - Rothman Index

KW - surgical ICU

UR - http://www.scopus.com/inward/record.url?scp=85063713613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063713613&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002191

DO - 10.1097/TA.0000000000002191

M3 - Article

VL - 86

SP - 635

EP - 641

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -