ArticleCritical care explorations2022
Defining Physiological Decompensation: An Expert Consensus and Retrospective Outcome Validation.
Article in Critical care explorations, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Factors underpinning the performance of implemented artificial intelligence-based patient deterioration prediction systems: reasons for selection and implications for hospitals and researchers.Journal of the American Medical Informatics Association : JAMIA · 2025Pooled it
- Systematic review and longitudinal analysis of implementing Artificial Intelligence to predict clinical deterioration in adult hospitals: what is known and what remains uncertain.Journal of the American Medical Informatics Association : JAMIA · 2024Pooled it
- DETERIO-LLM: enhancing traditional deterioration risk scores with clinical context and advanced reasoning.JAMIA open · 2026Article
- Predicting In-Hospital Cardiac Arrest Using Machine Learning Models: Protocol for a Scoping Review.JMIR research protocols · 2025Article
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- Comparison of Multimodal Deep Learning Approaches for Predicting Clinical Deterioration in Ward Patients: Observational Cohort Study.Journal of medical Internet research · 2025Observational
- Large-bore aspiration thrombectomy for the treatment of pulmonary embolism in octogenarians.CVIR endovascular · 2025Article
- Large-bore Aspiration Thrombectomy with the FlowTriever System for the Treatment of Pulmonary Embolism: A Large Single-Center Retrospective Analysis.Cardiovascular and interventional radiology · 2024Article
- Development and Validation of a Deep Learning Model for Prediction of Adult Physiological Deterioration.Critical care explorations · 2024Article
- Beyond Unplanned ICU Transfers: Linking a Revised Definition of Deterioration to Patient Outcomes.Critical care medicine · 2024Article
- Intensive care unit admission criteria: a scoping review.Journal of the Intensive Care Society · 2024Article
- Early Warning Systems for Critical Illness Outside the Intensive Care Unit.Critical care clinics · 2024Review
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Authors and funding
12 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesPhysiological decompensation of hospitalized patients is common and is associated with substantial morbidity and mortality. Research surrounding patient decompensation has been hampered by the absence of a robust definition of decompensation and lack of standardized clinical criteria with which to identify patients who have decompensated. We aimed to: 1) develop a consensus definition of physiological decompensation and 2) to develop clinical criteria to identify patients who have decompensated.
designWe utilized a three-phase, modified electronic Delphi (eDelphi) process, followed by a discussion round to generate consensus on the definition of physiological decompensation and on criteria to identify decompensation. We then validated the criteria using a retrospective cohort study of adult patients admitted to the Hospital of the University of Pennsylvania.
settingQuaternary academic medical center. PATIENTS: Adult patients admitted to the Hospital of the University of Pennsylvania who had triggered a rapid response team (RRT) response between January 1, 2019, and December 31, 2020.
interventionsNone. MEASUREMENTS AND MAIN
resultsSixty-nine experts participated in the eDelphi. Participation was high across the three survey rounds (first round: 93%, second round: 94%, and third round: 98%). The expert panel arrived at a consensus definition of physiological decompensation, "An acute worsening of a patient's clinical status that poses a substantial increase to an individual's short-term risk of death or serious harm." Consensus was also reached on criteria for physiological decompensation. Invasive mechanical ventilation, severe hypoxemia, and use of vasopressor or inotrope medication were bundled as criteria for our novel decompensation metric: the adult inpatient decompensation event (AIDE). Patients who met greater than one AIDE criteria within 24 hours of an RRT call had increased adjusted odds of 7-day mortality (adjusted odds ratio [aOR], 4.1 [95% CI, 2.5-6.7]) and intensive care unit transfer (aOR, 20.6 [95% CI, 14.2-30.0]).
conclusionsThrough the eDelphi process, we have reached a consensus definition of physiological decompensation and proposed clinical criteria with which to identify patients who have decompensated using data easily available from the electronic medical record, the AIDE criteria.
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