scholarly journals Patient or family perceived deterioration in functional status and outcome after intensive care admission: a retrospective cohort analysis of routinely collected data

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039416
Author(s):  
Jamie L Gross ◽  
Jacek Borkowski ◽  
Stephen J Brett
Keyword(s):  
Intensive Care ◽  
Hospital Discharge ◽  
Cohort Analysis ◽  
North West ◽  
Icu Admission ◽  
Routinely Collected Data ◽  
Retrospective Cohort Analysis ◽  
Mortality Outcome ◽  
Data Source ◽  
Functional Deterioration

ObjectiveTo explore the association of patient or family reported functional deterioration (defined by a single question) in the preceding year, with mortality outcome for those admitted to the intensive care unit (ICU).DesignRetrospective observational analysis of a routinely collected data source.ParticipantsPatients that were admitted to the ICU at Northwick Park and St Marks Hospitals, London North West University Healthcare NHS Trust between 01 October 2017 to 15 June 2019 were included. Patients were excluded if they had a prior ICU admission during the existing hospital episode or if information on functional deterioration could not be retrieved from either the patient or their advocate.Primary outcomesMortality at the point of hospital discharge and 1 year following admission to the ICU.ResultsOf the 1006 patients who were admitted to the ICU during the study period, information on functional deterioration was available for 621 patients who were included in the analysis. From these, 251 (40.4%) patients had patient or family reported functional deterioration in the preceding year, while 370 (59.6%) patients had a perceived stable functional baseline. Comparing the two groups, mortality was significantly higher in those who had functionally deteriorated compared with those with stable baseline function, at the point of hospital discharge (45.4% vs 25.9%; p<0.0001) and at 1 year (59.4% vs 33.0%; p<0.0001).ConclusionPatient or family reported functional deterioration was significantly associated with higher mortality at the point of hospital discharge and at 1 year. The concept of functional deterioration in the lead up to ICU admission warrants further exploration.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

2021 ◽  
pp. 000992282110472
Author(s):  
Andrew Brown ◽  
Mary Quaile ◽  
Hannah Morris ◽  
Dmitry Tumin ◽  
Clayten L. Parker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Care Coordination ◽  
Chronic Conditions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Admission ◽  
Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

scholarly journals Risk Factors and Outcomes Associated with Multidrug-Resistant Acinetobacter baumannii upon Intensive Care Unit Admission

2017 ◽  
Vol 62 (1) ◽  
Author(s):  
Natalia Blanco ◽  
Anthony D. Harris ◽  
Clare Rock ◽  
J. Kristie Johnson ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Cohort Analysis ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Content Type ◽  
Icu Admission

ABSTRACT Multidrug-resistant (MDR) Acinetobacter baumannii, associated with broad-spectrum antibiotic use, is an important nosocomial pathogen associated with morbidity and mortality. This study aimed to investigate the prevalence of MDR A. baumannii perirectal colonization among adult patients upon admission to the intensive care unit (ICU) over a 5-year period and to identify risk factors and outcomes associated with colonization. A retrospective cohort analysis of patients admitted to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) at the University of Maryland Medical Center from May 2005 to September 2009 was performed using perirectal surveillance cultures on admission. Poisson and logistic models were performed to identify associated risk factors and outcomes. Four percent of the cohort were positive for MDR A. baumannii at ICU admission. Among patients admitted to the MICU, those positive for MDR A. baumannii at admission were more likely to be older, to have received antibiotics before ICU admission, and to have shorter length of stay in the hospital prior to ICU admission. Among patients admitted to the SICU, those colonized were more likely to have at least one previous admission to our hospital. Patients positive for MDR A. baumannii at ICU admission were 15.2 times more likely to develop a subsequent positive clinical culture for A. baumannii and 1.4 times more likely to die during the current hospitalization. Risk factors associated with MDR A. baumannii colonization differ by ICU type. Colonization acts as a marker of disease severity and of risk of developing a subsequent Acinetobacter infection and of dying during hospitalization. Therefore, active surveillance could guide empirical antibiotic selection and inform infection control practices.

Long-term outcomes of patients admitted to an intensive care unit with intentional self-harm

2021 ◽  
pp. 0310057X2097898
Author(s):  
Matthew J Maiden ◽  
Roth Trisno ◽  
Mark E Finnis ◽  
Catherine M Norrish ◽  
Anne Mulvey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Cause Of Death ◽  
Relative Survival ◽  
Term Survival ◽  
Factors Associated ◽  
Icu Admission ◽  
Self Harm

Self-harm is one of the most common reasons for admission to an intensive care unit (ICU). While most patients with self-harm survive the ICU admission, little is known about their outcomes after hospital discharge. We conducted a retrospective cohort study of patients in the Barwon region in Victoria admitted to the ICU with self-harm (between 1998 and 2018) who survived to hospital discharge. The primary objective was to determine mortality after hospital discharge, and secondarily estimate relative survival, years of potential life lost, cause of death and factors associated with death. Over the 20-year study period, there were 710 patients in the cohort. The median patient age was 37 years (interquartile range (IQR) 26–48 years). A total of 406 (57%) were female, and 527 (74%) had a prior psychiatric diagnosis. The incidence of ICU admission increased over time (incidence rate ratio 1.05; 95% confidence interval (CI) 1.03–1.06 per annum). There were 105 (15%) patients who died after hospital discharge. Relative survival decreased each year after discharge, with the greatest decrement during the first 12 months. At ten years, relative survival was 0.85 (95% CI 0.81–0.88). The median years of potential life lost was 35 (IQR 22–45). Cause of death was self-harm in 27%, possible self-harm in 32% and medical disease in 41%. The only factors associated with mortality were male sex, older age and re-admission to ICU with self-harm. Further population studies are required to confirm these findings, and to understand what interventions may improve long-term survival in this relatively young group of critically ill patients.

scholarly journals Trends in Mortality in an Australian Tertiary Surgical Neonatal Intensive Care Unit

2018 ◽  
Vol 7 (1) ◽  
pp. 4
Author(s):  
Joseph Kiran Tauro ◽  
Karen Walker ◽  
Robert Halliday ◽  
Vishal Jatana ◽  
Amit Trivedi
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Mortality Rate ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
Surgical Condition ◽  
Neonatal Population ◽  
Median Birth Weight

Aim: The aim of the study was to estimate mortality rate and trend in the neonate admitted to a surgical neonatal intensive care unit.Methods: This study was a retrospective cohort analysis of all neonatal (from birth toResults: There were a total of 8994 admissions with 425 deaths during the study period, of whom 328 infants met inclusion criteria. In this group 18.9% (n=62) were admitted for a surgical condition, 35.4% (n=116) for cardiac disease and 45.7% (n=150) for other reasons. The median birth weight was 2715g (IQR 1890g-3220g) and the median gestational age was 37 weeks (IQR 33-39 weeks). The inter-quartile range for length of stay was between 2 to 20 days. The overall mortality rate was 3.6% over 16 years. There was a decline in mortality rate from 5.9% in 2000 to 3.5% in 2015 (p=0.06). Female infants accounted for 41% of the deaths. On multivariate analysis only very low birth weight was an independent predictor of mortality for surgical and cardiac deaths compared to deaths by other cause.Conclusions: There has been an overall decline in mortality in the surgical neonatal population from 2000 to 2015.

scholarly journals The weekend effect for stroke patients admitted to intensive care: A retrospective cohort analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0234521
Author(s):  
William Greig Mitchell ◽  
Rohit Pande ◽  
Tom Edward Robinson ◽  
Gabriel Davis Jones ◽  
Isabella Hou ◽  
...  
Keyword(s):  
Intensive Care ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Weekend Effect ◽  
Stroke Patients ◽  
Retrospective Cohort Analysis
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