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Critical Care
Published in: Critical Care 6/2008

Open Access 01-12-2008 | Research

A systematic review on quality indicators for tight glycaemic control in critically ill patients: need for an unambiguous indicator reference subset

Authors: Saeid Eslami, Nicolette F de Keizer, Evert de Jonge, Marcus J Schultz, Ameen Abu-Hanna

Published in: Critical Care | Issue 6/2008

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Abstract

Introduction

The objectives of this study were to systematically identify and summarize quality indicators of tight glycaemic control in critically ill patients, and to inspect the applicability of their definitions.

Methods

We searched in MEDLINE® for all studies evaluating a tight glycaemic control protocol and/or quality of glucose control that reported original data from a clinical trial or observational study on critically ill adult patients.

Results

Forty-nine studies met the inclusion criteria; 30 different indicators were extracted and categorized into four nonorthogonal categories: blood glucose zones (for example, 'hypoglycaemia'); blood glucose levels (for example, 'mean blood glucose level'); time intervals (for example, 'time to occurrence of an event'); and protocol characteristics (for example, 'blood glucose sampling frequency'). Hypoglycaemia-related indicators were used in 43 out of 49 studies, acting as a proxy for safety, but they employed many different definitions. Blood glucose level summaries were used in 41 out of 49 studies, reported as means and/or medians during the study period or at a certain time point (for example, the morning blood glucose level or blood glucose level upon starting insulin therapy). Time spent in the predefined blood glucose level range, time needed to reach the defined blood glucose level target, hyperglycaemia-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 importantly, many definitions are not precise, 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 from which to develop a standard list of well defined indicators that are associated with clinical outcomes or that concur with clinicians' subjective views on the quality of the regulatory process.
Appendix
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Metadata
Title
A systematic review on quality indicators for tight glycaemic control in critically ill patients: need for an unambiguous indicator reference subset
Authors
Saeid Eslami
Nicolette F de Keizer
Evert de Jonge
Marcus J Schultz
Ameen Abu-Hanna
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2008
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7114

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