Parsonnet score is a good predictor of the duration of intensive care unit stay following cardiac surgery

• Published in: Heart (British Cardiac Society) Vol. 83; no. 4; pp. 429 - 432
• Main Authors: Lawrence, D R, Valencia, O, Smith, E E J, Murday, A, Treasure, T
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2000; BMJ; BMJ Publishing Group LTD
• Subjects: Age; Aged; Biological and medical sciences; Cardiac Surgical Procedures; Female; Health Status Indicators; Heart attacks; Heart surgery; Humans; Intensive care; Intensive Care Units - organization & administration; Interventional Cardiology Surgery; length of hospital stay; Length of Stay; London; Male; Medical sciences; Mortality; Ostomy; Parsonnet score; Postoperative Care; Postoperative Complications; Prognosis; Prospective Studies; rationing; Risk Factors; ROC Curve; Stroke; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; London; Heart; Human; Postoperative; Score test; Prognosis; Surgery; Exploration; Duration; Hospitalization; Technique; Predictive factor; Intensive care unit
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heart.83.4.429

OBJECTIVE To investigate the value of the Parsonnet score (PS) in identifying preoperatively patients that are likely to spend < 24 hours on the intensive care unit (ICU) following cardiac surgery. METHOD Prospectively collected data on 5591 patients were analysed. PS, mortality, the length of stay on the ICU (ICU-LOS), number of patients with clinical evidence of stroke, need for haemofiltration, resternotomy for bleeding, tracheostomy, and use of intra-aortic balloon pump were documented as outcomes. A receiver operating characteristic (ROC) curve constructed using PS as a predictor of ICU stay < 24 hours identified a PS of 10 as the best cut off point that would predict ICU-LOS < 24 hours. The patients were therefore stratified by PS into two groups, those with a PS of 0 to 9 (PS 0–9) and those with a PS of 10 and above (PS 10+). RESULTS The ROC curve constructed using PS as a predictor of ICU stay < 24 hours had an area under the curve of 0.70 (0.01). The maximum efficiency of the test was at a sensitivity of 0.68. This corresponded to PS 10. The positive predictive value of the test at this score was 90.5%. Patients with PS 0–9 had a mean ICU stay of 1.49 days, while patients with PS 10+ had a mean ICU stay of 2.89 days (p = 0.01). The risk of stroke, use of intra-aortic balloon pump, requirement for haemofiltration, need for tracheostomy, and risk of resternotomy for bleeding were each significantly less in patients with PS 0–9 versus those with a score of PS 10+ (p < 0.01 in all cases). The risk of a single complication was 4.7% (PS 0–9)v 15.2% (PS 10+) (p < 0.01). CONCLUSION PS is an impartial and objective method of predicting postoperative complications and ICU stay < 24 hours. This is of value in selecting a cohort of patients likely to maintain a smooth flow of patients through the cardiothoracic unit when resources are limited to a few free ICU beds.