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

Objective-To investigate the value of the Parsonnet score (PS) in identifyi ng preoperatively patients that are likely to spend < 24 hours on the inten sive care unit (ICU) following cardiac surgery. Method-Prospectively collected data on 5591 patients were analysed. PS, mor tality, the length of stay on the ICU (ICU-LOS), number of patients with cl inical evidence of stroke, need for haemofiltration, resternotomy for bleed ing, 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 th erefore 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 rest was at a sensitivity of 0.68. This corresponded to PS 10. The pos itive predictive value of the test at this score was 90.5%. Patients with F S 0-9 had a mean ICU stay of 1.49 days, while patients with PS 10+ had a me an ICU stay of 2.89 days (p = 0.01). The risk of stroke, use of intra-aorti c 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). T he 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 postoperat ive 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.