title: Early prediction of new-onset physical disability after intensive care unit stay: a preliminary instrument.
abstract: BACKGROUND
  Many intensive care unit (ICU) survivors suffer from physical disability for months after ICU stay. There is no structured method to identify patients at risk for such problems. The purpose of the study was to develop a method for early in-ICU prediction of the patient's individual risk for new-onset physical disability two months after ICU stay.
  
  
  METHODS
  In total, 23 potential predictors for physical disability were assessed before individual ICU discharge. Two months after ICU discharge, out of 232 eligible patients, 148 ICU survivors (64%) completed the activity of daily living (ADL) staircase questionnaire to determine new-onset physical disability.
  
  
  RESULTS
  A total of 95% percent of patients had no ADL reduction prior to ICU admission. 47% (n = 69) of questionnaire responders suffered from worsened ADL. We identified four independent predictors for new-onset physical disability: Low educational level (odds ratio (OR) =6.8), impaired core stability (OR = 4.6), fractures (OR = 4.5) and ICU length of stay longer than 2 days (OR = 2.6). The predictors were included in a screening instrument. The regression coefficient of each predictor was transformed into a risk score. The sum of risk scores was related to a predicted probability for physical disability in the individual patient. The cross-validated area under receiver operating characteristics curve (AUC) for the screening instrument was 0.80.
  
  
  CONCLUSIONS
  Educational level is the single most important predictor for new-onset physical disability 2 months after ICU stay, followed by impaired core stability at ICU discharge, the presence of fractures and ICU stay longer than 2 days. A simple screening instrument based on these predictors can be used at ICU discharge to determine the risk for new-onset physical disability. This preliminary instrument may help clinicians to identify patients in need of support, but needs external validation prior to wider clinical use.
authors: Anna
authors: A
authors: Schandl
authors: Matteo
authors: M
authors: Bottai
authors: Ulrika
authors: U
authors: Holdar
authors: Elisabeth
authors: E
authors: Hellgren
authors: Peter
authors: P
authors: Sackey
mesh_terms: D000203:Activities of Daily Living; D015897:Comorbidity; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D005544:Forecasting / Q000379:methods; D050723:Fractures, Bone; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008603:Mental Health; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D004856:Postural Balance; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012678:Sensation Disorders; D012720:Severity of Illness Index; D017741:Survivors / Q000706:statistics & numerical data*; D013548:Sweden