Computable Phenotypes of Patient Acuity in the Intensive Care Unit

Continuous monitoring and patient acuity assessments are key aspects of Intensive Care Unit (ICU) practice, but both are limited by time constraints imposed on healthcare providers. Moreover, anticipating clinical trajectories remains imprecise. The objectives of this study are to (1) develop an electronic phenotype of acuity using automated variable retrieval within the electronic health records and (2) describe transitions between acuity states that illustrate the clinical trajectories of ICU patients. We gathered two single-center, longitudinal electronic health record datasets for 51,372 adult ICU patients admitted to the University of Florida Health (UFH) Gainesville (GNV) and Jacksonville (JAX). We developed algorithms to quantify acuity status at four-hour intervals for each ICU admission and identify acuity phenotypes using continuous acuity status and k-means clustering approach. 51,073 admissions for 38,749 patients in the UFH GNV dataset and 22,219 admissions for 12,623 patients in the UFH JAX dataset had at least one ICU stay lasting more than four hours. There were three phenotypes: persistently stable, persistently unstable, and transitioning from unstable to stable. For stable patients, approximately 0.7%-1.7% would transition to unstable, 0.02%-0.1% would expire, 1.2%-3.4% would be discharged, and the remaining 96%-97% would remain stable in the ICU every four hours. For unstable patients, approximately 6%-10% would transition to stable, 0.4%-0.5% would expire, and the remaining 89%-93% would remain unstable in the ICU in the next four hours. We developed phenotyping algorithms for patient acuity status every four hours while admitted to the ICU. This approach may be useful in developing prognostic and clinical decision-support tools to aid patients, caregivers, and providers in shared decision-making processes regarding escalation of care and patient values.