_id

683a1627c782e11e38d1b224

id

10020

complaint

[ "Chest Pain", "Shortness of Breath" ]

departments

[ "Cardiac" ]

description

The ACTION ICU Score for Intensive Care in NSTEMI predicts risk of NSTEMI complications requiring ICU care.

diseases

[ "Acute Coronary Syndrome", "Myocardial Infarction" ]

evidence

The ACTION ICU Score was developed retrospectively from 29,973 patients in the ACTION registry, with an overall ICU complication rate of 14.3%. In the derivation cohort, the score performed with R² = 0.94, C-statistic 0.73 (95% CI 0.72-0.74). It has not yet been prospectively validated in a separate population.

formula

full_title

ACTION ICU Score for Intensive Care in NSTEMI

information

Interpretation:

input_schema

[ { "conditionality": "", "default": 0, "label_en": "Age, years", "name": "age", "optional": false, "options": [ { "label": "<70", "value": 0 }, { "label": "≥70", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "Serum creatinine, mg/dL", "name": "cr", "optional": false, "options": [ { "label": "<1.1", "value": 0 }, { "label": "≥1.1", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "Heart rate, bpm", "name": "hr", "optional": false, "options": [ { "label": "<85", "value": 0 }, { "label": "85-100", "value": 1 }, { "label": "≥100", "value": 3 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "Systolic blood pressure, mmHg", "name": "bp", "optional": false, "options": [ { "label": "≥145", "value": 0 }, { "label": "125-145", "value": 1 }, { "label": "<125", "value": 3 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "Ratio of initial troponin to upper limit of normal", "name": "troponin", "optional": false, "options": [ { "label": "<12", "value": 0 }, { "label": "≥12", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "Signs or symptoms of heart failure", "name": "hf", "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 5 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "ST segment depression on EKG", "name": "stdep", "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Prior revascularization", "name": "pci", "optional": false, "options": [ { "label": "Yes", "value": 0 }, { "label": "No", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Chronic lung disease", "name": "lung", "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

Use in emergency patients with NSTEMI.

ismed

true

keywords

ICU, MI, heart attack, cardiac arrest, NSTEMI, STEMI, ACTION registry

measurements

[]

med_description

Predicts risk of NSTEMI complications requiring ICU care.

next_actions

This predictive tool should not replace clinical judgment. Not all factors benefiting from ICU care can be accounted for in this score.

next_advice

• Patients with low risk for complications requiring ICU care may be considered for admission outside of an ICU setting.

• Patients with high risk for complications requiring ICU care may benefit from early admission to the ICU.  

next_management

• Hospital systems should define their own threshold for ICU admission, based on ICU capacity, non-ICU resource availability, etc.

• For example, an ACTION ICU threshold of 5 might triage 50% of patients to the ICU, with an expected complication rate of <10% for non-ICU patients, while an ACTION ICU threshold of 12 might triage 50% of only very high risk patients to the ICU.

pearls

• Derived in patients ≥65 years old, and may not apply to younger patients.

• Different institutions may use different thresholds for ICU admission.

• Not yet prospectively validated.

published

purpose

[ "Prognosis" ]

reasons

Helps identify patients who are initially stable but may later develop complications requiring a higher level of care, and may therefore help with disposition and avoiding failure to rescue.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "http://jaha.ahajournals.org/content/7/11/e008894 ", "text": "Fanaroff AC, Chen AY, Thomas LE, et al. Risk Score to Predict Need for Intensive Care in Initially Hemodynamically Stable Adults With Non-ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc. 2018;7(11)." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21167342", "text": "Chin CT, Chen AY, Wang TY, et al. Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the acute coronary treatment and intervention outcomes network (ACTION) registry-get with the guidelines (GWTG) acute myocardial infarction mortality model and risk score. Am Heart J. 2011;161(1):113-122.e2." }, { "href": "https://www.ncbi.nlm.nih.gov/books/NBK83609/", "text": "National Clinical Guidelines Centre (UK). Stable Angina: Methods, Evidence & Guidance [Internet]. London: Royal College of Physicians (UK); 2011 Jul. (NICE Clinical Guidelines, No. 126.) 14, Risk scores. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83609/." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776676/", "text": "Fanaroff AC, Peterson ED, Chen AY, et al. Intensive Care Unit Utilization and Mortality Among Medicare Patients Hospitalized with Non-ST-Segment Elevation Myocardial Infarction. JAMA Cardiol. 2017;2(1):36-44." } ], "Outcomes": [], "Validation": [], "Validations": [] }

related

[ { "calcId": 10563, "short_title_en": "SEX-SHOCK score", "slug": "sex-shock-risk-score-development-cardiogenic-shock" }, { "calcId": 10403, "short_title_en": "SAPS 3", "slug": "simplified-acute-physiology-score-saps-3" }, { "calcId": 38, "short_title_en": "Framingham Risk Score (Hard Coronary Heart Disease)", "slug": "framingham-risk-score-hard-coronary-heart-disease" } ]

search_terms

[ "ICU risk score", "stemi", "nstemi complications", "mortality risk score" ]

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

seo

{ "keywords_en": "ICU, MI, heart attack, cardiac arrest, NSTEMI, STEMI, ACTION registry", "meta_description_en": "The ACTION ICU Score for Intensive Care in NSTEMI predicts risk of NSTEMI complications requiring ICU care." }

short_description

short_title

ACTION ICU Score

slug

action-icu-score-intensive-care-nstemi

specialty

[ "Cardiology", "Critical Care", "Family Practice", "Internal Medicine" ]

tags

[]

title

ACTION ICU Score for Intensive Care in NSTEMI

usecase

• Emergency patients with NSTEMI, to predict likelihood of complications requiring ICU care for patients with NSTEMI.

• Should not be used in patients with STEMI, cardiogenic shock, or cardiac arrest.

version_number

versions

[]

cleaned_departments

[ "cardiology" ]

cleaned_use

[ "Emergency patients with NSTEMI, to predict likelihood of complications requiring ICU care for patients with NSTEMI.", "Should not be used in patients with STEMI, cardiogenic shock, or cardiac arrest." ]

pub

false