ICU discharge screening for prediction of new-onset physical disability - a multinational cohort study.

BACKGROUND: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge.

METHODS: Multinational prospective cohort study in ten general ICUs in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability three months post-ICU, defined as a ≥10 score reduction in the Barthel Index compared to baseline.

RESULTS: Of 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea Critical Care Physical Assessment Tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81 to 0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61 to 0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, positive predictive value for a high-risk group (CPAx score ≤18) was 0.32.

CONCLUSION: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.