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J Trauma Acute Care Surg. 2019 Jan 8. doi: 10.1097/TA.0000000000002191. [Epub ahead of print]

Application of EMR-derived analytics in critical care: Rothman Index predicts mortality and readmissions in surgical ICU patients.

Author information

1
Cleveland Clinic, Cleveland Ohio 44195.
2
University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229.
3
University Health System, San Antonio, Texas 78229.

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 pre 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, and 67% were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs 11 days, p<.05) as well as higher mortality (2.5% vs 0.6%, p<.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<.05 for all).Categorizing RI scores 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%, RI>65 = 0%, p<.05) and SICU readmission rates (RI<40 =9%, RI 40-65= 5.2%, RI>65 = 2.8%, p<.05). Patients transferred with RI scores > 83 did not require SICU readmission within 48 hours.

CONCLUSION:

SICU 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 pre- and post-transfer RI scores compared to those who do not. RI scores may be used as a clinical tool for evaluating patients prior to transfer from the SICU. Prospective studies are warranted to further validate use of this technology.

LEVEL OF EVIDENCE:

3 STUDY TYPE: Retrospective database review.

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