Abstract 4145943: Recidivism in the Cardiac Intensive Care Unit: Insights from the Multinational Critical Care Cardiology Trials Network
Bibliographic record
Abstract
Background: Intensive Care Unit (ICU) readmission, or recidivism, can lead to increased resource use, longer hospital length-of-stay (LOS), higher costs,&worse survival. Given the potential clinical&financial impact of recidivism, it may be a useful quality metric for unit-&hospital-level comparisons. No prior studies, however, have comprehensively explored recidivism – its potential causes or consequences – across Cardiac Intensive Care Units (CICUs). Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions were captured (n=16,705)&those with > 1 readmission during the same hospitalization were identified. Multivariable logistic regression was used to determine baseline variables associated with recidivism, as well as the association of recidivism with in-hospital mortality. Results: A total of 1287 pts (7.7%) had CICU readmission. These pts were younger (p=0.015), had more diabetes (p=0.04), prior heart failure (HF)&chronic kidney disease (CKD) (p<0.001 for both), more frequently presented with decompensated HF or cardiogenic shock (p<0.001), were more often transferred from outside facilities (p<0.001), and had higher Sequential Organ Failure Assessment (SOFA) scores at presentation (p<0.001). Rates of CICU recidivism highly varied across institutions ( Fig-A ). Compared to those who were not readmitted, those readmitted to the CICU had greater critical care resource use during their 1 st CICU stay ( Fig-B ), along with longer initial CICU LOS (2.8 vs 2.2d)&hospital LOS (20.4 vs 7.6d) (both p<0.001). Hospital mortality was 20.3% in those readmitted to the CICU compared to 4.5% in those without readmission ( Fig-C ); adjusted odds ratio 6.22 (95% CI 5.25-7.38, p<0.001). This remained statistically significant after adjustment for code status. Conclusions: CICU recidivism varies significantly across centers and is associated with numerous comorbidities, higher illness severity, and greater resource use. One of every 5 pts readmitted to the CICU died in the hospital. Recidivism should be measured in future CICU-based studies, and could help to assess quality of CICU care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".