Application of EMR-derived analytics in critical care: Rothman Index predicts mortality and readmissions in surgical ICU patients

Introduction The Rothman Index (RI) is an objective measurement of a patient’s overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality. Methods We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016. Data included demographics, length of stay (LOS), mortality, and RI at multiple pre and post transfer time points. Results A total of 1,445 SICU patients were transferred to the surgical floor; 79 patients (5.5%) were readmitted within 48 hours of transfer. Mean age was 52, and 67% were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs 11 days, p<.05 as well higher mortality vs p patients requiring readmission also had a lower ri at and hours before transfer after for all categorizing scores into higher-risk medium-risk lower-risk groups>65), RI scores at 24 hours before transfer were inversely proportional to overall mortality (RI65 = 0%, p<.05 and sicu readmission rates ri>65 = 2.8%, p<.05 patients transferred with ri scores> 83 did not require SICU readmission within 48 hours. Conclusion SICU patients requiring readmission within 48 hours of transfer have a significantly higher mortality and longer LOS compared to those who do not. Patients requiring readmission also have significantly lower pre- and post-transfer RI scores compared to those who do not. RI scores may be used as a clinical tool for evaluating patients prior to transfer from the SICU. Prospective studies are warranted to further validate use of this technology. Level of Evidence 3 Study type Retrospective database review Funding source: None. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Level of Evidence: 3 (Retrospective database review) This paper was presented at the 77th Annual Meeting of AAST and 4th World Trauma Congress (Oral Presentation, Sep 26 - 29, 2018, San Diego, California) Corresponding Author: Ramon F. Cestero, MD FACS FCCM, E-mail: Cestero@uthscsa.edu, Phone: 210 743 4154 © 2019 Lippincott Williams & Wilkins, Inc.

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