The Chelsea Critical Care Physical Assessment Tool (CPAx) is designed to evaluate physical function and activity in critically ill adults. This article examines a study investigating the tool’s predictive validity for 90-day outcomes after intensive care unit (ICU) discharge.
Predicting Residence at Home After ICU Discharge
A prospective clinimetric study evaluated the CPAx’s accuracy in predicting patient outcomes within 90 days of ICU discharge. The primary hypothesis proposed moderate accuracy (AUROC = 0.750) in predicting residence at home. The study included critically ill adults recruited within 72-144 hours of mechanical ventilation. Results demonstrated good accuracy (AUROC = 0.778) for the CPAx in predicting a return home within 90 days.
Secondary Outcomes and Correlations
Beyond predicting home residence, the study explored the CPAx’s ability to differentiate between hospital discharge destinations, correlate with health-related quality of life, and correlate with length of ICU stay. The CPAx score significantly increased across discharge groups: “undesirable” ≤ “rehabilitation” ≤ “home” (p < 0.001). However, correlation with subsequent health-related quality of life was weak (physical: r = 0.261, mental: r = 0.193). As expected, baseline CPAx scores negatively correlated with ICU length of stay (r = -0.443). This suggests that higher initial CPAx scores, indicating better physical function, are associated with shorter ICU stays.
Clinical Implications of the CPAx
The study concluded that the CPAx demonstrates good predictive validity for residence at home and general discharge destinations within 90 days of ICU discharge. While the tool may not effectively predict health-related quality of life, its ability to forecast discharge location and potential need for rehabilitation is valuable. A CPAx score of ≥18 at ICU discharge exhibits 80% sensitivity and 70% specificity in predicting a return home within 90 days.
Conclusion: The CPAx as a Predictive Tool
The CPAx offers valuable insights into the potential recovery trajectory of critically ill adults. This tool can aid healthcare professionals in identifying rehabilitation needs, advising on recovery, and screening patients for post-discharge follow-up. While further research is needed, the CPAx shows promise as a valuable tool in predicting patient outcomes after critical illness.
