Dados do Trabalho

Título

Characteristics and outcomes of patients admitted to Intensive Care unit and Step-down unit following a Rapid Response Team activation based on subjective criteria ("worried” staff)

Objetivo

To describe characteristics and outcomes of patients admitted to the intensive care (ICU) or step-down (SDU) unit after a rapid response team (RRT) activation based on the subjective criteria "worried” staff.

Métodos

A retrospective cohort study conducted in a quaternary private care hospital. All adult patients admitted to the ICU/SDU between 2012-2020 after RRT activation were categorized and analyzed according to the RRT activation criteria (Subjective and Objective Criteria). The main outcome of interest was hospital mortality.

Resultados

3841 patients were included in the analysis [Subjective Criteria: 853 (22.2%) patients; Objective Criteria: 2988 (77.8%) patients]. The Subjective Criteria group was younger [65 (48-80) vs. 71 (54-83) years; p<0.001], had a lower SAPS3 score [47 (38-56) vs. 53 (43-62); p<0.001], a lower Charlson Comorbidity Index [1 (0-3) vs. 2 (0-3); p<0.001], was less frequently admitted to the ICU (43% vs. 54%; p<0.001), received vasopressors (9% vs. 19%; p<0.001), noninvasive ventilation (14% vs. 28%; p<0.001), mechanical ventilation (9% vs. 16%; p<0.001) and renal replacement therapy (4% vs. 7%; p=0.003) less frequently and exhibited a lower crude hospital mortality (11% vs. 19%; p<0.001) compared to the Objective Criteria group. Nevertheless, after adjusting for SAPS3 score, hospital mortality did not differ between the groups (OR 0.78, 95%CI: 0.61-1.01; p=0.057).

Conclusão

The subjective criterion of "worried” staff enhances multidisciplinary team situational awareness, allowing for a prompt recognition and treatment of clinical deterioration on ward patients.