Dr. Julien Viau-Lapointe1, Dr. Tiffany Yeretsian2, Dr. Rizwana Ashraf2, Dr. Rohan D'Souza2, Dr. Stephen Lapinsky3
1Université de Montréal, Montreal, Canada, 2McMaster University, Hamilton, Canada, 3University of Toronto, Toronto, Canada
Biography:
Stephen Lapinsky is a Pulmonary and Critical Care physician at Mount Sinai Hospital in Toronto and Professor of Medicine at the University of Toronto. His clinical and research interests are in critical illness and pulmonary diseases in the pregnant patient.
Abstract:
Background: There is little consistency in how outcomes are reported and measured in critically ill obstetric patients. Our objective was to develop a Core Outcome Set (COS) for Research on Critically Ill Obstetric Patients (COSCO).
Study Design: Building on previous work, which identified 23 unique outcomes through a systematic review and qualitative stakeholder interviews, this study undertook an international consensus approach, wherein health service users (HSUs) and healthcare professionals (HCPs) were asked to participate in Delphi surveys, small group meetings, and a consensus meeting to determine the COS.
Results: A total of 44 HSUs and HCPs rated the 23 outcomes in a two-round Delphi surveys, following which, consensus was obtained through 3 small group discussions involving 2 HSUs and 10 HCPS and a final consensus meeting involving 9 HCPs. COSCO includes 10 outcomes:
1. Maternal all-cause mortality.
2. Cardiac arrest and need for cardiopulmonary resuscitation.
3. Severe (maternal) organ dysfunction requiring major intervention.
4. Length of stay in intensive care unit (ICU) and total stay in hospital.
5. Readmission to hospital or ICU or repeated hospital/emergency department visits following ICU admission.
6. Presence of a new medical condition at the time of discharge from hospital.
7. Permanent infertility as a consequence of critical illness or intervention.
8. Fetal/neonatal loss.
9. Severe neonatal morbidity requiring prolonged neonatal ICU admission.
10. Gestational age / preterm delivery.
Items that did not qualify as core were re-assigned as ‘important but not core outcomes’, minimal data items, and clinical practice recommendations.
Conclusion: This international consensus study identified core outcomes and other important data items to be reported in all studies on critically ill obstetric patients. This will enable harmonization of outcome reporting and measurement, aiding meta-analyses and informing clinical practice and health policy.
Keywords
Critical care, pregnancy, consensus study, Delphi survey, core outcome set, patient-important outcomes.