title: Soft tissue oxygenation and risk of mortality (STORM): an early marker of critical illness?
abstract: OBJECTIVE
  Tissue oxygen saturation (StO2) is a noninvasive measure that reflects changes in tissue perfusion. Rapid response teams (RRTs) assess sick inpatients to determine need for intensive care unit (ICU) admission. This determination is subjective based on parameters such as systolic blood pressure, heart rate, and pulse oximetry. Our objective was to determine if parameters readily available at RRT bedside assessment (vital signs and StO2) can predict ICU admission and inhospital mortality.
  
  
  METHODS
  All inpatients assessed by RRT at a tertiary Canadian hospital were consecutively sampled for 3 months. After clinical assessment, the RRT physician (blinded to StO2) made the ultimate ICU admission decision.
  
  
  RESULTS
  In 134 included patients, mean age was 65.5 ± 15.2 years, and 53% (n = 71) were males. There were 49 ICU admissions (36.6%) and 31 mortalities (23.1%). Two multivariable models significantly predicted ICU admission and inhospital mortality. The only independent predictor of ICU admission was pulse oximetry (adjusted odds ratio, 0.88; 95% confidence interval, 0.80-0.96; P = .007). Tissue oxygen saturation did not predict ICU admission but was the only independent predictor of mortality (adjusted odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .04).
  
  
  CONCLUSIONS
  Tissue oxygen saturation may identify critical illness in patients who would not traditionally meet ICU admission criteria and thus may identify patients who benefit from closer monitoring.
authors.affiliation: Western University, Schulich School of Medicine & Dentistry, General Surgery, London, Canada; London Health Sciences Centre, General Surgery, London, Canada; McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, Canada.
authors.forename: Biniam
authors.initials: B
authors.lastname: Kidane
authors.affiliation: Western University, Schulich School of Medicine & Dentistry, General Surgery, London, Canada; London Health Sciences Centre, General Surgery, London, Canada; McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, Canada.
authors.forename: Sami A
authors.initials: SA
authors.lastname: Chadi
authors.affiliation: Western University, Schulich School of Medicine & Dentistry, General Surgery, London, Canada; London Health Sciences Centre, General Surgery, London, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Di Labio
authors.affiliation: London Health Sciences Centre, Critical Care Medicine, London, Canada.
authors.forename: Fran
authors.initials: F
authors.lastname: Priestap
authors.affiliation: London Health Sciences Centre, Critical Care Medicine, London, Canada; Western University, Schulich School of Medicine & Dentistry, Critical Care Medicine, London, Canada.
authors.forename: Wael
authors.initials: W
authors.lastname: Haddara
authors.affiliation: Western University, Schulich School of Medicine & Dentistry, General Surgery, London, Canada; London Health Sciences Centre, Critical Care Medicine, London, Canada; Western University, Schulich School of Medicine & Dentistry, Critical Care Medicine, London, Canada. Electronic address: tina.mele@lhsc.on.ca.
authors.forename: Tina
authors.initials: T
authors.lastname: Mele
authors.affiliation: Western University, Schulich School of Medicine & Dentistry, Anaesthesia & Perioperative Medicine, London, Canada; London Health Sciences Centre, Anaesthesia & Perioperative Medicine, London, Canada.
authors.forename: John M
authors.initials: JM
authors.lastname: Murkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016638:Critical Illness; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D012306:Risk; D062606:Tertiary Care Centers
keywords: Critical care; Rapid response team; Tissue oxygenation