(448) The utility of severity scoring systems to identify obstetric transports at risk for ICU escalation

Prevention of severe maternal morbidity requires prompt identification of the critically-ill patient requiring intensive care (ICU). We aim to describe different severity scores associated with obstetric transports initially admitted to labor and delivery (L&D) but require escalation to the ICU. Specifically we evaluate the SOFA, APACHE-II, Shock (SI) and ROX (ROXi) index scoring systems.

Study Design:

This is a retrospective cohort study of obstetric transports to a single tertiary medical center from 01/1/2017-12/31/2021. EMR was used to collect demographics, maternal risk factors, indication for ICU escalation, lab values, and severity scores at arrival and 24 hours after admission. Propensity score 1-to-1 matching using a 0.1 caliper was used to match patients escalated to the ICU with obstetric patients that did not need ICU. Patients were matched by age, antepartum or postpartum on admission and admitting clinical diagnoses.

Results:

A total of 1,794 obstetric transport patients were directly admitted to L&D with 52 patients requiring escalation to the ICU during their admission. Of these, 34 ICU escalation were matched with 37 that did not require ICU. There were no differences in the demographic data between the two groups, Table 1. SOFA, APACHE-II, and ROXi scores were significantly higher in patient requiring ICU escalation (p=0.001), with no difference in SI. When comparing 24 hours after admission, SOFA and APACHE II scores were higher (p=0.001), with no difference in SI or ROXi. Median time to ICU escalation was 18.7 h and length of stay were longer for patients requiring ICU (12.7d vs 3.7d, p=0.001),Table 2.

Conclusion:

In obstetric transport patients, SOFA and APACHE-II were consistently higher on admission and 24 hours after admission in patients that were escalated as compared to those not requiring escalation to the ICU. Future research is needed to develop cut-offs or a composite score to determine whether obstetric transports are appropriate for direct admission to L&D versus the ICU.