Introduction The aim of the study was to assess whether adults admitted to Intensive Care Units (ICUs) with Intermediate Care Units (IMCU) in the hospital have a lower in-hospital mortality than those admitted to ICUs without an IMCU. Methods Observational multinational cohort study performed on patients admitted to participating ICUs during four weeks. IMCU was defined as any physically and administratively independent unit open 24/24 and 7/7 providing a level of care lower than ICU but higher than ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all causes in-hospital patient mortality until hospital discharge (censored at 90 days). Results 167 ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, for a total of 1.397 (23.9%) in hospital deaths. The illness severity was higher for patients in ICUs with an IMCU (median SAPSII 37) than for patients in ICUs without an IMCU (median SAPSII: 29, p<0.001). After adjustment for patient characteristics at admission such as their illness severity and for ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95%CI 0.45-0.88, p=0.007) in favor of the presence of IMCU.. The protective effect of the IMCU was absent among patients who were admitted for basic observation, e.g., after surgery (odds ratio 1.15, 95% CI 0.65-2.03, p=0.630) but was strong among patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37-0.80, p=0.002). Conclusions The presence of intermediate care unit in the hospital is associated with a significantly reduced adjusted hospital mortality of adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment.
Hospital mortality of adults admitted to ICU in hospitals with and without Intermediate Care Unit: A multicentre European cohort study
VOLTA, Carlo Alberto;
2014
Abstract
Introduction The aim of the study was to assess whether adults admitted to Intensive Care Units (ICUs) with Intermediate Care Units (IMCU) in the hospital have a lower in-hospital mortality than those admitted to ICUs without an IMCU. Methods Observational multinational cohort study performed on patients admitted to participating ICUs during four weeks. IMCU was defined as any physically and administratively independent unit open 24/24 and 7/7 providing a level of care lower than ICU but higher than ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all causes in-hospital patient mortality until hospital discharge (censored at 90 days). Results 167 ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, for a total of 1.397 (23.9%) in hospital deaths. The illness severity was higher for patients in ICUs with an IMCU (median SAPSII 37) than for patients in ICUs without an IMCU (median SAPSII: 29, p<0.001). After adjustment for patient characteristics at admission such as their illness severity and for ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95%CI 0.45-0.88, p=0.007) in favor of the presence of IMCU.. The protective effect of the IMCU was absent among patients who were admitted for basic observation, e.g., after surgery (odds ratio 1.15, 95% CI 0.65-2.03, p=0.630) but was strong among patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37-0.80, p=0.002). Conclusions The presence of intermediate care unit in the hospital is associated with a significantly reduced adjusted hospital mortality of adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
