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Unexpected intensive care transfer of admitted patients with severe sepsis

Overview of attention for article published in Journal of Intensive Care, July 2017
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (83rd percentile)

Mentioned by

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18 tweeters
facebook
1 Facebook page

Citations

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11 Dimensions

Readers on

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35 Mendeley
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Title
Unexpected intensive care transfer of admitted patients with severe sepsis
Published in
Journal of Intensive Care, July 2017
DOI 10.1186/s40560-017-0239-7
Pubmed ID
Authors

Gabriel Wardi, Arvin R. Wali, Julian Villar, Vaishal Tolia, Christian Tomaszewski, Christian Sloane, Peter Fedullo, Jeremy R. Beitler, Matthew Nolan, Daniel Lasoff, Rebecca E. Sell

Abstract

Patients with severe sepsis generally respond well to initial therapy administered in the emergency department (ED), but a subset later decompensate and require unexpected transfer to the intensive care unit (ICU). This study aimed to identify clinical factors that can predict patients at increased risk for delayed transfer to the ICU and the association of delayed ICU transfer with mortality. This is a nested case-control study in a prospectively collected registry of patients with severe sepsis and septic shock at two EDs. Cases had severe sepsis and unexpected ICU transfer within 48 h of admission from the ED; controls had severe sepsis but remained in a non-ICU level of care. Univariate and multivariate regression analyses were used to identify predictors of unexpected transfer to the ICU, which was the primary outcome. Differences in mortality between these two groups as well as a cohort of patients directly admitted to the ICU were also calculated. Of the 914 patients in our registry, 358 patients with severe sepsis were admitted from the ED to non-ICU level of care; 84 (23.5%) had unexpected ICU transfer within 48 h. Demographics and baseline co-morbidity burden were similar for patients requiring versus not requiring delayed ICU transfer. In unadjusted analysis, lactate ≥4 mmol/L and infection site were significantly associated with unexpected ICU upgrade. In forward selection multivariate logistic regression analysis, lactate ≥4 mmol/L (OR 2.0, 95% CI 1.03, 3.73; p = 0.041) and night (5 PM to 7 AM) admission (OR 1.9, 95% CI 1.07, 3.33; p = 0.029) were independent predictors of unexpected ICU transfer. Mortality of patients who were not upgraded to the ICU was 8.0%. Patients with unexpected ICU upgrade had similar mortality (25.0%) to those patients with severe sepsis/septic shock (24.6%) who were initially admitted to the ICU, despite less severe indices of illness at presentation. Serum lactate ≥4 mmol/L and nighttime admissions are associated with unexpected ICU transfer in patients with severe sepsis. Mortality among patients with delayed ICU upgrade was similar to that for patients initially admitted directly to the ICU.

Twitter Demographics

The data shown below were collected from the profiles of 18 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 35 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 35 100%

Demographic breakdown

Readers by professional status Count As %
Other 7 20%
Student > Bachelor 5 14%
Student > Master 4 11%
Student > Ph. D. Student 3 9%
Librarian 2 6%
Other 6 17%
Unknown 8 23%
Readers by discipline Count As %
Medicine and Dentistry 20 57%
Nursing and Health Professions 3 9%
Engineering 2 6%
Chemistry 1 3%
Economics, Econometrics and Finance 1 3%
Other 0 0%
Unknown 8 23%

Attention Score in Context

This research output has an Altmetric Attention Score of 12. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 September 2017.
All research outputs
#2,369,243
of 20,627,629 outputs
Outputs from Journal of Intensive Care
#120
of 471 outputs
Outputs of similar age
#46,578
of 282,468 outputs
Outputs of similar age from Journal of Intensive Care
#1
of 1 outputs
Altmetric has tracked 20,627,629 research outputs across all sources so far. Compared to these this one has done well and is in the 88th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 471 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 10.8. This one has gotten more attention than average, scoring higher than 74% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 282,468 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 83% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them