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The need for ICU admission in intoxicated patients: a prediction model.
Clin Toxicol (Phila) 2017; 55(1):4-11CT

Abstract

CONTEXT

Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary.

OBJECTIVE

The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical ventilation and/or vasopressors <24 h of the ICU admission and/or in-hospital mortality).

MATERIALS AND METHODS

We performed a retrospective cohort study from a national ICU-registry, including 86 Dutch ICUs. We aimed to include only observational admissions and therefore excluded admissions with treatment, at the start of the admission that can only be applied on the ICU (mechanical ventilation or CPR before admission). First, a generalized linear mixed-effects model with binominal link function and a random intercept per hospital was developed, based on covariates available in the first hour of ICU admission. Second, the selected covariates were used to develop a prediction model based on a practical point system. To determine the performance of the prediction model, the sensitivity, specificity, positive, and negative predictive value of several cut-off points based on the assigned number of points were assessed.

RESULTS

9679 admissions between January 2010 until January 2015 were included for analysis. In total, 632 (6.5%) of the patients admitted to the ICU eventually turned out to actually need ICU treatment. The strongest predictors for ICU treatment were respiratory insufficiency, age >55 and a GCS <6. Alcohol and "other poisonings" (e.g., carbonmonoxide, arsenic, cyanide) as intoxication type and a systolic blood pressure ≥130 mmHg were indicators that ICU treatment was likely unnecessary. The prediction model had high sensitivity (93.4%) and a high negative predictive value (98.7%).

DISCUSSION AND CONCLUSION

Clinical use of the prediction model, with a high negative predictive value (98.7%), would result in 34.3% less observational admissions.

Authors+Show Affiliations

a Department of Intensive Care Medicine , University Medical Center, University of Utrecht , Utrecht , The Netherlands. b Dutch National Poisons Information Centre (NPIC) , University Medical Center, University of Utrecht , Utrecht , The Netherlands.c Department of Medical Informatics , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.c Department of Medical Informatics , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.a Department of Intensive Care Medicine , University Medical Center, University of Utrecht , Utrecht , The Netherlands.a Department of Intensive Care Medicine , University Medical Center, University of Utrecht , Utrecht , The Netherlands. b Dutch National Poisons Information Centre (NPIC) , University Medical Center, University of Utrecht , Utrecht , The Netherlands. d Institute for Risk Assessment Sciences (IRAS), University of Utrecht , Utrecht , The Netherlands.a Department of Intensive Care Medicine , University Medical Center, University of Utrecht , Utrecht , The Netherlands. b Dutch National Poisons Information Centre (NPIC) , University Medical Center, University of Utrecht , Utrecht , The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27644313

Citation

Brandenburg, Raya, et al. "The Need for ICU Admission in Intoxicated Patients: a Prediction Model." Clinical Toxicology (Philadelphia, Pa.), vol. 55, no. 1, 2017, pp. 4-11.
Brandenburg R, Brinkman S, de Keizer NF, et al. The need for ICU admission in intoxicated patients: a prediction model. Clin Toxicol (Phila). 2017;55(1):4-11.
Brandenburg, R., Brinkman, S., de Keizer, N. F., Kesecioglu, J., Meulenbelt, J., & de Lange, D. W. (2017). The need for ICU admission in intoxicated patients: a prediction model. Clinical Toxicology (Philadelphia, Pa.), 55(1), pp. 4-11. doi:10.1080/15563650.2016.1222616.
Brandenburg R, et al. The Need for ICU Admission in Intoxicated Patients: a Prediction Model. Clin Toxicol (Phila). 2017;55(1):4-11. PubMed PMID: 27644313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The need for ICU admission in intoxicated patients: a prediction model. AU - Brandenburg,Raya, AU - Brinkman,Sylvia, AU - de Keizer,Nicolette F, AU - Kesecioglu,Jozef, AU - Meulenbelt,Jan, AU - de Lange,Dylan W, Y1 - 2016/09/20/ PY - 2016/9/21/pubmed PY - 2017/3/7/medline PY - 2016/9/21/entrez KW - Critical care KW - costs KW - outcome KW - overdose KW - poisoning SP - 4 EP - 11 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 55 IS - 1 N2 - CONTEXT: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. OBJECTIVE: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical ventilation and/or vasopressors <24 h of the ICU admission and/or in-hospital mortality). MATERIALS AND METHODS: We performed a retrospective cohort study from a national ICU-registry, including 86 Dutch ICUs. We aimed to include only observational admissions and therefore excluded admissions with treatment, at the start of the admission that can only be applied on the ICU (mechanical ventilation or CPR before admission). First, a generalized linear mixed-effects model with binominal link function and a random intercept per hospital was developed, based on covariates available in the first hour of ICU admission. Second, the selected covariates were used to develop a prediction model based on a practical point system. To determine the performance of the prediction model, the sensitivity, specificity, positive, and negative predictive value of several cut-off points based on the assigned number of points were assessed. RESULTS: 9679 admissions between January 2010 until January 2015 were included for analysis. In total, 632 (6.5%) of the patients admitted to the ICU eventually turned out to actually need ICU treatment. The strongest predictors for ICU treatment were respiratory insufficiency, age >55 and a GCS <6. Alcohol and "other poisonings" (e.g., carbonmonoxide, arsenic, cyanide) as intoxication type and a systolic blood pressure ≥130 mmHg were indicators that ICU treatment was likely unnecessary. The prediction model had high sensitivity (93.4%) and a high negative predictive value (98.7%). DISCUSSION AND CONCLUSION: Clinical use of the prediction model, with a high negative predictive value (98.7%), would result in 34.3% less observational admissions. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/27644313/The_need_for_ICU_admission_in_intoxicated_patients:_a_prediction_model L2 - http://www.tandfonline.com/doi/full/10.1080/15563650.2016.1222616 DB - PRIME DP - Unbound Medicine ER -