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Rothman Index Variability Predicts Clinical Deterioration and Rapid Response Team Activation
*Brian Wengerter, *Kevin Pei, *David Asuzu, Kimberly A Davis
Yale University School of Medicine, New Haven, CT
Objective: Rothman Index (RI) incorporates 26 clinical variables covering vital signs, lab values, and nursing assessment into a global indicator of inpatient acuity. Sparse literature is available to describe overall utility in surgical patients or specifically address to what degree changes in RI reflect deterioration over time. Our aim is to evaluate if RI variability can predict rapid response team (RRT) activation in surgical patients.
Design: Retrospective cohort study. Electronic medical records were queried for all patients from three representative surgical wards from 2012-2015 (14,825 patient encounters).
Setting: Tertiary academic hospital.
Patients: Surgical patients on dedicated surgical wards during the study period were included for analysis. RI incorporates multiple nursing assessments; therefore, each patient who underwent RRT activation was matched to four randomly selected control patients who were present on the same ward during the same time period to minimize the effect of staff change.
Interventions: None.
Main Outcome Measures: The primary outcome measured is RRT activation.
Results: 217 patients underwent a RRT activation during the study period. RI variability was gauged by Maximum Minus Minimum RI (MMRI) and RI Standard Deviation (RISD) within a 24 hour period before RRT activation. MMRI predicted RRT with odds ratio (OR) 1.10 (95% CI 1.08, 1.12, p<0.001) and area under receiver operating characteristic (AUROC) curve of 0.76 (95% CI 0.72, 0.79). RISD predicted RRT with OR 1.31 (95% CI 1.24, 1.38, p<0.001) and AUROC of 0.74 (95% CI 0.70, 0.77).
Conclusions: RI variability predicted likelihood of rapid response activation. Future prospective studies are needed to determine feasibility of reallocating resources toward patients with unstable RI.
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