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In the surgical intensive care unit (SICU), goals of critical care are often discussed in long-term ventilated patients around the time of extubation. Muscle weakness predicts extubation failure but formal muscle strength assessment by the Medical Research Council scale is time-consuming and not part of the daily clinical exam. In this observational study, we hypothesize that COMA measurement, routinely used by the SICU nurses, is a reliable and valid predictor for patients' SICU outcomes. This prospective observational study is carried out within a consecutively enrolled cohort of adult patients who are extubated in two SICUs at Massachusetts General Hospital, Boston.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adverse discharge disposition | Patients who were discharged to a skilled nursing facility or died in the hospital |
| |
| No adverse discharge disposition | Patients who were not discharged to a skilled nursing facility or did not die in the hospital |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| COMA Score Assessment | Procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Adverse discharge disposition | Within one day after hospital discharge |
| Measure | Description | Time Frame |
|---|---|---|
| ICU length of stay | Time frame within 24 hours after ICU admission and within 24 hours after ICU discharge | |
| Hospital length of stay | Time frame within 24 hours after hospital admission and within 24 hours after hospital discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Validation: Receiver operating curve (ROC) analysis - Acute Physiology and Chronic Health Evaluation II | ROC curve of COMA compared to ROC curve of Acute Physiology and Chronic Health Evaluation (APACHE) II | At the day of admission to the ICU as well as within 72 hours after extubation |
| Validation: Receiver operating curve (ROC) analysis - Charlson Comorbidity Index |
Inclusion Criteria:
Exclusion Criteria:
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Study cohort of adult patients who are extubated in two SICUs at Massachusetts General Hospital, Boston.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Massachusetts General Hospital | Boston | Massachusetts | 02114 | United States |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D018908 | Muscle Weakness |
| ID | Term |
|---|---|
| D001519 | Behavior |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D020879 | Neuromuscular Manifestations |
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| 30-day mortality | Within 30-days after extubation in the ICU or until the day of hospital discharge |
| Hospital costs | Between the day of hospital admission and the day of hospital discharge |
| 30-day hospital readmission | Within 30 days after discharge from the index hospital stay |
ROC curve of COMA compared to ROC curve of Charlson Comorbidity Index (CCI) |
| At the day of admission to the ICU as well as within 72 hours after extubation |
| Validation: Receiver operating curve (ROC) analysis - Richmond Agitation and Sedation Score | ROC curve of COMA compared to ROC curve of Richmond Agitation and Sedation Score (RASS) | Within 72 hours after extubation |
| Validation: Receiver operating curve (ROC) analysis - Confusion Assessment Method ICU score | ROC curve of COMA compared to ROC curve of Confusion Assessment Method (CAM) ICU score | Within 72 hours after extubation |
| Validation: weighed kappa statistics | Inter-rater agreement with COMA score between A.M. and P.M. shift nurse | Within 72 hours after extubation |
| Validation: correlation between COMA and actual skeletal muscle index assessed by computer tomography | Skeletal muscle index is measured at the level of the 3rd lumbar vertebrae | Within 72 hours after extubation |
| D009461 |
| Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |