A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score.
BACKGROUND
Mortality in the ward after an intensive care unit (ICU) stay is considered a quality parameter, and is described as a source of avoidable mortality. Additionally, the attending intensivist frequently anticipates fatal outcome after ICU discharge. Our objective was to test the ability of a new score to stratify patients according to ward mortality after ICU discharge.


METHODS
A prospective cohort study was performed in the general ICU of a university-affiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome.


RESULTS
We studied 1,521 patients with a mean age of 60.2 +/- 17.8 years. The median (25-75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. Post-ICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84-0.93) for the Sabadell score.


CONCLUSIONS
The Sabadell score at ICU discharge works effectively to stratify patients according to hospital outcome.
Fernandez
Rafael
R
Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n, 08208, Sabadell, Spain. rfernandez@cspt.es
Baigorri
Francisco
F
Navarro
Gema
G
Artigas
Antonio
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment