0951: Frailty and functional status as decision factors regarding admission to critical care

Published Date: 03rd January 2018

Publication Authors: Andrews FJ, Feeney J, Tridente A

INTRODUCTION
Pressure on Critical Care (CC) services is significant, with a progressively more complex patient population with increasing comorbidities. Admission may be inappropriate if the patient is unlikely to benefit from it. Guidance published in the past may no longer reflect current practice [1–2]. Clinical frailty is associated with worse outcomes in critically ill patients [3].

OBJECTIVES
We aimed to establish the impact of frailty measures and other factors on the decision to admit critically ill patient to CC.

METHODS
Data on unplanned patient referrals made between November 2013 and February 2015 were collected, including patient demographics, acute physiological parameters, prior hospital length of stay (LOS), comorbidities and indices of frailty. Logistic regression analysis was used to assess factors influencing admission, using STATA 10. Results are expressed as median (interquartile range) and odds ratios (OR) for admission, with 95% confidence intervals (95%CI).

RESULTS
Data were collected on 943 patients referred to CC, of whom 411 (43.6%) were admitted. Median age was 65 (50–76) years, 482 (51.1%) were male and the median LOS prior to referral was 0 (0–2) days. The majority of patients were referred out of hours (496, 52.6%). The majority of patients were referred from medical specialties (384, 40.7%), the emergency department (261, 27.7%) and surgical specialties (198, 21%). Among those not admitted, 125 (13.3%) were declined as functional status was deemed too poor and 80 (8.5%) because death was deemed certain. At single variable logistic regression analysis adjusted for age and gender, predictors of admission were an increase in EWS (early warning score, an index of acute physiological derangement, OR for each point increase 1.14, 95% CI 1.04-1.26, p =0.007), shorter hospital stay (OR for each additional day inpatient stay 0.97, 95%CI 0.94-0.99, p = 0.033), lower frailty score (OR for each point increase in score 0.77, 95%CI 0.68- 0.86, p < 0.001), being self-caring (OR 2.52, 95%CI 1.74-3.65, p < 0.001). Being housebound (OR 0.34, 95%CI 0.23-0.49, p < 0.001) or wheelchair-bound (OR 0.35, 95%CI 0.21-0.6, p < 0.001) were both significantly associated with admission being declined.

CONCLUSIONS
Frailty and functional status appear to be the major factors in decision making regarding admission to CC, after adjusting for age and gender. Quantification of frailty is a valuable tool in admission prediction and may allow risk stratification and adequate resource allocation, deserving further investigation

 Tridente, A.; Feeny, J.; Andrews, F. et al. (2017). 0951: Frailty and functional status as decision factors regarding admission to critical care. Intensive Care Medicine Experimental . 5 (suppl 2), p478

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