Incidence and Prediction of Unstable Blood Glucose Level among Critically Ill Patients: A Cohort Study.

PURPOSE: To evaluate the incidence and the prediction of unstable blood glucose level among critically ill patients hospitalized in an intensive care unit. METHODS: A cohort study was conducted with 62 adult patients hospitalized at an intensive care unit of a hospital located in Minas Gerais, Brazil, between March and July of 2017. Patient's demographic information, along with scores for Simplified Acute Physiology Score III, primary medical diagnosis, discharge status, diagnosis of diabetes and/or sepsis, length of stay, glycemic variability, type of nutrition, types of medications and treatments, and oxygen therapy were collected daily. A daily venous blood sample was collected to measure blood glucose levels during the patient's hospitalization period. Bivariate analysis was used to explore the association among the potential diagnostic indicators and the outcome of unstable blood glucose levels. Multivariate Cox regression was used to identify the potential predictors for the outcome. FINDINGS: Of the total of 62 participants, 45.1% (n=28) had unstable blood glucose level. Among the 28 patients with unstable blood glucose levels, half of them (n=14, 50%) had hypoglycemia and the other half had hyperglycemia (n=14, 50%). Decreased number of days hospitalized and the use of intensive glucose control with regular insulin were associated with decreased odds of developing hyperglycemia. The presence of mechanical ventilation was associated with a higher risk for the development of hypoglycemia. CONCLUSIONS: This study provides knowledge and evidence of diagnostic indicators for unstable blood glucose levels that are not currently included in the NANDA-International terminology for the nursing diagnosis Risk for unstable blood glucose level (00179). IMPLICATIONS FOR NURSING PRACTICE: This study identified important diagnostic indicators that nurses can observe during the assessment to identify patients that are at risk for developing unstable blood glucose level and provide the appropriate care.

OBJETIVO: Avaliar a incidência e predição de glicemia instável em pacientes adultos internados em uma Unidade de Terapia Intensiva. MÉTODO: Estudo de coorte concorrente, realizada entre março e julho de 2017, com amostra de 62 pacientes. As variáveis independentes coletadas da admissão do paciente a unidade foram sexo, raça, idade, Simplified Acute Physiology Score III, diagnóstico de internação, tipo de saída, diabetes, sepse, tempo de permanência, variabilidade glicêmica, tipo de nutrição, medicamentos e terapêutica, e oxigenoterapia (cateter nasal e ventilação mecânica). Os dados foram analisados por estatística descritiva e análise de sobrevida com teste de Log-rank e regressão multivariada de Cox. RESULTADOS: Dos 62 pacientes, 45,1% (n=28) desenvolveram a glicemia instável. Dos 28 pacientes com glicemia instável, metade (n=14, 50%) apresentou hipoglicemia, e a outra metade apresentou hiperglicemia (n=14, 50%). Menor tempo de permanência e controle estrito da glicemia foram fatores de proteção para desenvolvimento de hiperglicemia. Ventilação mecânica foi associada ao desenvolvimento de hipoglicemia. CONCLUSÃO: Este estudo fornece conhecimento e evidência sobre indicadores diagnósticos para o desenvolvimento de glicemia instável, que atualmente não estão incluídos na terminologia da NANDA-Internacional para o diagnóstico de enfermagem Risco de glicemia instável. IMPLICAÇÕES PARA ENFERMAGEM: Este trabalho contribui para o aperfeiçoamento da Taxonomia da NANDA-Internacional e, por conseguinte, da linguagem padronizada de enfermagem.

Relationship between risk stratification, mortality and length of stay in a Emergency Hospital / Relación entre la estratificación del riesgo, la mortalidad y el tiempo de permanencia en un servicio de Urgencias / Relação entre estratificação de risco, mortalidade e tempo de permanência em um hospital de urgência

Objective:To evaluate the relationship between risk stratification, mortality and hospital length of stay in emergency medical services. Methodology. A prospective cohort study that used the information in the ALERTÒ database of the HOSPUB to know the evolution of patients classified by nurses using the Manchester Risk Classification Triage System in the emergency medical services, of the Belo Horizonte Municipal Hospital - MG, Brazil. Results. 147,167 patients were analyzed, 5.9% were female. The most common risk classification was yellow (47.4%), followed by green (36.5%), orange (14.2%), blue (1.3%) and red (0.6%). The mean length of stay was less than one day in 95.4% of patients who were discharged from the hospital. Thirty percent of the patients classified as red, 2% of those classified as orange, and 0.3% of those classified as yellow died. There was direct a relationship between the severity of patient classification and the length of hospital stay. Conclusion. The risk classification system used by nurses in the hospital was a good predictor of death and hospital length of stay for patients admitted to the emergency medical services.

Objetivo:Evaluar la relación entre la estratificación del riesgo en el servicio de Urgencias, la mortalidad y el tiempo de permanencia hospitalaria. Metodología. Estudio descriptivo retrospectivo en el cual se utilizó la información de la base de datos ALERTÒ el HOSPUB para conocer la evolución de los pacientes clasificados por los enfermeros con el Sistema de Triage de Manchester de Clasificación del Riesgo del Servicio de Urgencias del Hospital Municipal de Belo Horizonte - MG, Brasil. Resultados. Se analizaron 147 167 pacientes, el (55.9%) de sexo femenino. La clasificación del riesgo más frecuente fue la amarilla (47.4%), seguida por la verde" (36.5%), la naranja (14.2%), la azul (1.3%) y la roja (0.6%). La media de permanencia en el servicio fue menor a un día, el 95.4% de los pacientes fue dado de alta del hospital. El (30%) de los pacientes clasificados en rojo, el (2%) de los naranja y el (0.3%) de los amarillo, fallecieron. Se verificó la relación directa entre la gravedad del paciente en la clasificación y el tiempo de permanencia hospitalaria. Conclusión. El sistema de clasificación del riesgo empleado por las enfermeras en este hospital fue un buen predictor de muerte y permanencia en el hospital de los pacientes que ingresaron al servicio de urgencias.

Objetivo:avaliar a relação entre a estratificação pela classificação de risco, mortalidade e permanência hospitalar em um Hospital de Urgência. Metodologia: Estudo de coorte prospectivo o qual foi utilizado o banco de dados ALERT® e HOSPUB para conhecer a evolução dos pacientes classificados pelos enfermeiros através do Sistema de Triagem de Manchester de Classificação de Risco de um Hospital Municipal de Belo Horizonte -MG, Brasil. Resultados: Foram atendidos 147 167 pacientes, destes (55.9%) foram do sexo feminino. A classificação de risco mais frequente foi a amarela (47.4%), seguida da verde (36.5%), da laranja (14.2%), azul (1.3%) e a vermelha (0.6%). A média de permanência no serviço foi menor que um dia e 95.4% dos pacientes receberam alta hospitalar. Os (30%) dos pacientes classificados como vermelho, (2%) dos laranjas e (0.3%) dos amarelos morreram. Verificou-se relação direta entre a gravidade da classificação dos pacientes e o tempo de permanência hospitalar. Conclusão: O sistema de classificação de risco utilizado pelos enfermeiros deste hospital, foi um bom indicador para o risco de óbito e permanência hospitalar dos pacientes que foram admitidos nos serviço de urgência.

Relationship between risk stratification, mortality and length of stay in a Emergency Hospital.

OBJECTIVE: To evaluate the relationship between risk stratification, mortality and hospital length of stay in emergency medical services. METHODOLOGY: A prospective cohort study that used the information in the ALERTÒ database of the HOSPUB to know the evolution of patients classified by nurses using the Manchester Risk Classification Triage System in the emergency medical services, of the Belo Horizonte Municipal Hospital - MG, Brazil. RESULTS: 147,167 patients were analyzed, 5.9% were female. The most common risk classification was yellow (47.4%), followed by green (36.5%), orange (14.2%), blue (1.3%) and red (0.6%). The mean length of stay was less than one day in 95.4% of patients who were discharged from the hospital. Thirty percent of the patients classified as red, 2% of those classified as orange, and 0.3% of those classified as yellow died. There was direct a relationship between the severity of patient classification and the length of hospital stay. CONCLUSION: The risk classification system used by nurses in the hospital was a good predictor of death and hospital length of stay for patients admitted to the emergency medical services.