A systematic review on quality indicators for tight glycaemic control in critically ill patients - need for an unambiguous indicator reference subset.
Crit Care. 2008 Nov 11;12(6):R139
Authors: Eslami S, de Keizer NF, Schultz MJ, de Jonge E, Abu-Hanna A
ABSTRACT: INTRODUCTION: To systematically identify and summarize quality indicators of tight glycaemic control in critically ill patients, and inspect the applicability of their definitions. METHODS: All studies evaluating a tight glycaemic protocol and/or quality of glucose control that reported original data from a clinical trial or observational study on critically ill adult patients were searched in MEDLINE(R). RESULTS: 49 studies met the inclusion criteria; 30 different indicators were extracted and categorized in 4 non-orthogonal categories: blood glucose zones (e.g., "hypoglycemia"); blood glucose levels (BGL) (e.g., "mean BGL"); time intervals (e.g., "time to the occurrence of an event"); and protocol characteristics (e.g., "BG sampling frequency"). Hypoglycemia-related indicators were used in 43/49 studies -acting as proxy for safety but had many different definitions. Blood glucose level summaries were used in 41/49 studies -reported as means and/or medians during the study period or at a certain time point (e.g., the morning blood glucose level or blood glucose level at starting insulin therapy). Time spent in the predefined blood glucose level range, time needed to reach the defined blood glucose level target, hyperglycemia-related indicators and protocol related indicators were other frequently used indicators. Most indicators differ in their definitions even when they are meant to measure the same underlying concept. More important, many definitions are not crisp, prohibiting their applicability and hence the reproducibility and comparability of research results. CONCLUSIONS: An unambiguous indicator reference subset is necessary. The result of this systematic review can be used as a starting point to develop a standard list of well-defined indicators, which are associated with clinical outcomes or concur with clinicians' subjective views on the quality of the regulatory process.
PMID: 19014427 [PubMed - as supplied by publisher]