A Clinical Deterioration Prediction Tool for Internal Medicine Patients

Lisa L. Kirkland, Michael Malinchoc, Megan O'Byrne, Joanne T. Benson, Deanne T. Kashiwagi, M. Caroline Burton, Prathibha Varkey, Timothy Ian Morgenthaler

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Many early warning models for hospitalized patients use variables measured on admission to the hospital ward; few have been rigorously derived and validated. The objective was to create and validate a clinical deterioration prediction tool using routinely collected clinical and nursing measurements. Multivariate regression analysis was used to determine clinical variables statistically associated with clinical deterioration; subsequently, the model tool was retrospectively validated using a different cohort of medical inpatients. The Braden Scale (P = .01; odds ratio [OR] = 0.91; confidence interval [CI] = 0.84-0.98), respiratory rate (P < .01; OR = 1.08; CI = 1.04-1.13), oxygen saturation (P < .01; OR = 0.97; CI = 0.96-0.99), and shock index (P < .01; OR = 2.37; CI = 1.14-3.98) were predictive of clinical deterioration 2-12 hours in the future. When applied to the validation cohort, the tool demonstrated fair concordance with actual outcomes. This tool created using routinely collected clinical measurements can serve as a very early warning system for hospitalized medical patients.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalAmerican Journal of Medical Quality
Volume28
Issue number2
DOIs
StatePublished - 2013

Fingerprint

Internal Medicine
Odds Ratio
Confidence Intervals
Respiratory Rate
Inpatients
Shock
Nursing
Multivariate Analysis
Regression Analysis
Oxygen

Keywords

  • clinical deterioration
  • early warning systems
  • prediction
  • probability
  • rapid response

ASJC Scopus subject areas

  • Health Policy

Cite this

A Clinical Deterioration Prediction Tool for Internal Medicine Patients. / Kirkland, Lisa L.; Malinchoc, Michael; O'Byrne, Megan; Benson, Joanne T.; Kashiwagi, Deanne T.; Burton, M. Caroline; Varkey, Prathibha; Morgenthaler, Timothy Ian.

In: American Journal of Medical Quality, Vol. 28, No. 2, 2013, p. 135-142.

Research output: Contribution to journalArticle

Kirkland, LL, Malinchoc, M, O'Byrne, M, Benson, JT, Kashiwagi, DT, Burton, MC, Varkey, P & Morgenthaler, TI 2013, 'A Clinical Deterioration Prediction Tool for Internal Medicine Patients', American Journal of Medical Quality, vol. 28, no. 2, pp. 135-142. https://doi.org/10.1177/1062860612450459
Kirkland, Lisa L. ; Malinchoc, Michael ; O'Byrne, Megan ; Benson, Joanne T. ; Kashiwagi, Deanne T. ; Burton, M. Caroline ; Varkey, Prathibha ; Morgenthaler, Timothy Ian. / A Clinical Deterioration Prediction Tool for Internal Medicine Patients. In: American Journal of Medical Quality. 2013 ; Vol. 28, No. 2. pp. 135-142.
@article{1ce71fb1ec2b497dbfaf6853ee579a04,
title = "A Clinical Deterioration Prediction Tool for Internal Medicine Patients",
abstract = "Many early warning models for hospitalized patients use variables measured on admission to the hospital ward; few have been rigorously derived and validated. The objective was to create and validate a clinical deterioration prediction tool using routinely collected clinical and nursing measurements. Multivariate regression analysis was used to determine clinical variables statistically associated with clinical deterioration; subsequently, the model tool was retrospectively validated using a different cohort of medical inpatients. The Braden Scale (P = .01; odds ratio [OR] = 0.91; confidence interval [CI] = 0.84-0.98), respiratory rate (P < .01; OR = 1.08; CI = 1.04-1.13), oxygen saturation (P < .01; OR = 0.97; CI = 0.96-0.99), and shock index (P < .01; OR = 2.37; CI = 1.14-3.98) were predictive of clinical deterioration 2-12 hours in the future. When applied to the validation cohort, the tool demonstrated fair concordance with actual outcomes. This tool created using routinely collected clinical measurements can serve as a very early warning system for hospitalized medical patients.",
keywords = "clinical deterioration, early warning systems, prediction, probability, rapid response",
author = "Kirkland, {Lisa L.} and Michael Malinchoc and Megan O'Byrne and Benson, {Joanne T.} and Kashiwagi, {Deanne T.} and Burton, {M. Caroline} and Prathibha Varkey and Morgenthaler, {Timothy Ian}",
year = "2013",
doi = "10.1177/1062860612450459",
language = "English (US)",
volume = "28",
pages = "135--142",
journal = "American Journal of Medical Quality",
issn = "1062-8606",
publisher = "SAGE Publications Inc.",
number = "2",

}

TY - JOUR

T1 - A Clinical Deterioration Prediction Tool for Internal Medicine Patients

AU - Kirkland, Lisa L.

AU - Malinchoc, Michael

AU - O'Byrne, Megan

AU - Benson, Joanne T.

AU - Kashiwagi, Deanne T.

AU - Burton, M. Caroline

AU - Varkey, Prathibha

AU - Morgenthaler, Timothy Ian

PY - 2013

Y1 - 2013

N2 - Many early warning models for hospitalized patients use variables measured on admission to the hospital ward; few have been rigorously derived and validated. The objective was to create and validate a clinical deterioration prediction tool using routinely collected clinical and nursing measurements. Multivariate regression analysis was used to determine clinical variables statistically associated with clinical deterioration; subsequently, the model tool was retrospectively validated using a different cohort of medical inpatients. The Braden Scale (P = .01; odds ratio [OR] = 0.91; confidence interval [CI] = 0.84-0.98), respiratory rate (P < .01; OR = 1.08; CI = 1.04-1.13), oxygen saturation (P < .01; OR = 0.97; CI = 0.96-0.99), and shock index (P < .01; OR = 2.37; CI = 1.14-3.98) were predictive of clinical deterioration 2-12 hours in the future. When applied to the validation cohort, the tool demonstrated fair concordance with actual outcomes. This tool created using routinely collected clinical measurements can serve as a very early warning system for hospitalized medical patients.

AB - Many early warning models for hospitalized patients use variables measured on admission to the hospital ward; few have been rigorously derived and validated. The objective was to create and validate a clinical deterioration prediction tool using routinely collected clinical and nursing measurements. Multivariate regression analysis was used to determine clinical variables statistically associated with clinical deterioration; subsequently, the model tool was retrospectively validated using a different cohort of medical inpatients. The Braden Scale (P = .01; odds ratio [OR] = 0.91; confidence interval [CI] = 0.84-0.98), respiratory rate (P < .01; OR = 1.08; CI = 1.04-1.13), oxygen saturation (P < .01; OR = 0.97; CI = 0.96-0.99), and shock index (P < .01; OR = 2.37; CI = 1.14-3.98) were predictive of clinical deterioration 2-12 hours in the future. When applied to the validation cohort, the tool demonstrated fair concordance with actual outcomes. This tool created using routinely collected clinical measurements can serve as a very early warning system for hospitalized medical patients.

KW - clinical deterioration

KW - early warning systems

KW - prediction

KW - probability

KW - rapid response

UR - http://www.scopus.com/inward/record.url?scp=84874783923&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874783923&partnerID=8YFLogxK

U2 - 10.1177/1062860612450459

DO - 10.1177/1062860612450459

M3 - Article

C2 - 22822159

AN - SCOPUS:84874783923

VL - 28

SP - 135

EP - 142

JO - American Journal of Medical Quality

JF - American Journal of Medical Quality

SN - 1062-8606

IS - 2

ER -