Abstract 127: Comparison of Vital Sign Abnormalities Prior to Ward Cardiac Arrest vs Intensive Care Unit Transfer
INTRODUCTION: Previous studies have demonstrated that most patients who suffer cardiac arrest (CA) on the ward have abnormal vital signs prior to the event. However, no study to date has compared the vital signs of CA patients to patients transferred to the intensive care unit (ICU).
METHODS: All adult patients hospitalized at an academic institution from November 2008 to January 2011 were included in this retrospective study. Vital signs for each patient documented on the ward from admission until a first CA, first ICU transfer, or hospital discharge (controls) were extracted from an electronic medical record (EPIC, Verona, WI). The mean maximum and minimum values for each vital sign were compared between groups using t-tests. Area under the receiver operating characteristic curve (AUC) was also calculated for each vital sign by comparing the CA and ICU transfer groups to controls.
RESULTS: A total of 47427 patients were included in the study (2820 ICU transfers, 88 CA patients, and 44519 controls). Compared to ICU transfer patients, CA patients had a higher mean maximum heart rate and a lower mean minimum diastolic blood pressure and temperature (Table). The best predictors of CA were maximum respiratory rate (AUC 0.76), maximum heart rate (AUC 0.69), and minimum diastolic blood pressure (AUC 0.63). For ICU transfer, the best predictors were maximum respiratory rate (AUC 0.66), maximum heart rate (AUC 0.61), minimum oxygen saturation (AUC 0.58), and minimum systolic blood pressure (AUC 0.55).
CONCLUSIONS: Patients transferred to the ICU and those suffering CA both have significant vital sign abnormalities. Although the abnormalities are more severe in CA patients, they are not transferred to a higher-level of care. Further work into deriving a CA risk prediction model may assist in identifying these critically ill patients.
- © 2011 by American Heart Association, Inc.