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Oral Concurrent Session 6 - Medical Complications
Oral Concurrent Sessions
Expedited Sessions
Prevention of severe maternal morbidity requires prompt identification of the critically-ill patient requiring intensive care services (ICU). We aim to describe different severity scores associated obstetric transports that are 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 were used to collect demographics, maternal risk factors, indication for ICU escalation, severity scores at L&D admission and upon ICU escalation. Ordinal logistic regression analysis were used to assess the time interval to ICU escalation as related to individual predictors.
Results:
A total of 1,855 obstetric transport patients were reviewed during the study period. Of these, 1,794 patients were directly admitted to L&D with 52 patients requiring escalation to the ICU during their admission. Asthma (26.9%), hypertension (21.2%) and diabetes (21.2%) were the most common maternal comorbidity. The largest indication for ICU admission was acute respiratory failure (51%), followed by preeclampsia/eclampsia (19%), and cardiomyopathy (11.5%), Table 1. Median scores for SOFA and APACHE-II were higher from L&D admission to ICU escalation with the ROXi being lower upon ICU escalation. APACHE-II was the significantly correlated with ICU escalation within 12 hours (OR 1.44, CI 1.08-1.91, p=0.01), with no differences in SOFA, SI, or ROXi, Table 2. Hypertension and tobacco use were also positively correlated with ICU escalation after 24 hours.
Conclusion:
In obstetric patients initially transported to L&D and require ICU escalation, APACHE-II severity score was the strongest predictor of ICU escalation within 12 hours of admission. Scoring systems should be readily applied to facilitate timely transport to the ICU.
Emad Elsamadicy, MD, MS
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Jerry Yang, BS
University of Maryland School of Medicine
Baltimore, Maryland, United States
Vainavi Gambhir, BS
University of Maryland School of Medicine
Baltimore, Maryland, United States
Saad Pirzada, BS
University of Maryland School of Medicine
Baltimore, Maryland, United States
Anya Plotnikova, BS
University of Maryland School of Medicine
Baltimore, Maryland, United States
Manahel Zahid, BS
University of Maryland School of Medicine
Baltimore, Maryland, United States
Quincy Tran, MD, PhD
University of Maryland School of Medicine
Baltimore, Maryland, United States
Allison Lankford, MD
University of Maryland School of Medicine
College Park, Maryland, United States