title: Comparison of Unplanned Intensive Care Unit Readmission Scores: A Prospective Cohort Study.
abstract: OBJECTIVE
  Early discharge from the intensive care unit (ICU) may constitute a strategy of resource consumption optimization; however, unplanned readmission of hospitalized patients to an ICU is associated with a worse outcome. We aimed to compare the effectiveness of the Stability and Workload Index for Transfer score (SWIFT), Sequential Organ Failure Assessment score (SOFA) and simplified Therapeutic Intervention Scoring System (TISS-28) in predicting unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU.
  
  
  METHODS
  We conducted a prospective cohort study in a single tertiary hospital in southern Brazil. All adult patients admitted to the ICU for more than 24 hours from January 2008 to December 2009 were evaluated. SWIFT, SOFA and TISS-28 scores were calculated on the day of discharge from the ICU. A stepwise logistic regression was conducted to evaluate the effectiveness of these scores in predicting unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU. Moreover, we conducted a direct accuracy comparison among SWIFT, SOFA and TISS-28 scores.
  
  
  RESULTS
  A total of 1,277 patients were discharged from the ICU during the study period. The rate of unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU was 15% (192 patients). In the multivariate analysis, age (P = 0.001), length of ICU stay (P = 0.01), cirrhosis (P = 0.03), SWIFT (P = 0.001), SOFA (P = 0.01) and TISS-28 (P<0.001) constituted predictors of unplanned ICU readmission or unexpected death. The SWIFT, SOFA and TISS-28 scores showed similar predictive accuracy (AUC valueswere 0.66, 0.65 and 0.67, respectively; P = 0.58) [corrected].
  
  
  CONCLUSIONS
  SWIFT, SOFA and TISS-28 on the day of discharge from the ICU have only moderate accuracy in predicting ICU readmission or death. The present study did not find any differences in accuracy among the three scores.
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Regis Goulart
authors.initials: RG
authors.lastname: Rosa
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Cintia
authors.initials: C
authors.lastname: Roehrig
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.|School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Roselaine Pinheiro de
authors.initials: RP
authors.lastname: Oliveira
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Juçara Gasparetto
authors.initials: JG
authors.lastname: Maccari
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Ana Carolina Peçanha
authors.initials: AC
authors.lastname: Antônio
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Priscylla de Souza
authors.initials: Pde S
authors.lastname: Castro
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Felippe Leopoldo Dexheimer
authors.initials: FL
authors.lastname: Neto
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Patrícia de Campos
authors.initials: Pde C
authors.lastname: Balzano
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.|School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Cassiano
authors.initials: C
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D000368:Aged; D003643:Death; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D063305:Organ Dysfunction Scores; D010359:Patient Readmission; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016526:Workload