Rothman Index variability predicts clinical deterioration and rapid response activation

Am J Surg. 2018 Jan;215(1):37-41. doi: 10.1016/j.amjsurg.2017.07.031. Epub 2017 Aug 10.


Background: The overall utility of the Rothman Index (RI), a global measure of inpatient acuity, for surgical patients is unclear. We evaluate whether RI variability can predict rapid response team (RRT) activation in surgical patients.

Methods: Surgical patients who underwent RRT activation from 2013 to 2015 were matched to four control cases. RI variability was gauged by maximum minus minimum RI (MMRI) and RI standard deviation (RISD) within a 24-h period before RRT. The primary outcome measured was RRT activation, and our secondary outcome was in-hospital mortality.

Results: Two hundred seventeen (217) patients underwent RRT. RISD (odds ratio, OR, 1.31, 95% confidence interval, CI, 1.23-1.38, P < 0.001; area under receiver operating characteristic, AUROC, curve 0.74, 95% CI 0.70-0.77) and MMRI (OR 1.10, 95% CI 1.08-1.12, P < 0.001; AUROC 0.76, 95% CI 0.72-0.79) predicted increased likelihood of RRT.

Conclusions: RISD is predictive of RRT.

Keywords: Rapid response team; Rothman Index; Variability.

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Clinical Deterioration*
  • Female
  • Hospital Mortality
  • Hospital Rapid Response Team / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Acuity*
  • Postoperative Care*
  • ROC Curve
  • Retrospective Studies