Abstract 345: Hospital Variation in Admission to Intensive Care Units for Patients with Acute Myocardial Infarction

Background: The intensive care unit (ICU) has been credited with reducing mortality for patients hospitalized with AMI in a past era when life-threatening post-infarction ventricular arrhythmias were more common. With the evolution in the clinical profile and treatment of AMI, the marginal benefit of ICU care for many patients is less clear. As a result, the use of ICU care for patients with AMI may vary substantially among institutions, creating implications for treatment strategies and patient outcomes. Methods: We identified 114,980 hospitalizations for AMI from 311 hospitals in the 2009-10 Premier database using ICD-9-CM codes. We excluded hospitals with <25 AMI admissions, patients <18 yrs, and transfers. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. For each quartile, we calculated (1) usage rates of critical care therapies and (2) in-hospital risk-standardized mortality rates (RSMRs) among all patients admitted with AMI. Kruskal-Wallis and Cochran-Armitage Trend tests assessed for statistical significance. Results: ICU admission rates for AMI patients varied markedly among hospitals (median 48%, IQR 35%-61%, range 0%-98%, Figure). Hospitals admitting more AMI patients to the ICU (higher quartiles) were (1) more likely to use critical care therapies in AMI patients overall (mechanical ventilation [Q1 to Q4: 13% to 16%], vasopressors/inotropes [17% to 21%], intra-aortic balloon pumps [4% to 7%], and pulmonary artery catheters [4% to 5%]; p for trend<0.05 in all comparisons). However, (2) there was no association between the hospital ICU admission rate and overall RSMR for all AMI patients (6% all quartiles; p=0.7271, Figure). Conclusion: ICU admission rates for AMI vary substantially across hospitals with evidence of greater use of ICU therapies in high admitting hospitals but without evidence of lower overall mortality. There is a need for further research to determine the optimal use of ICU care for contemporary populations of patients with AMI.

Download Full-text

Prognostic Factors Predicting Survival in De Novo AML Patients Requiring Intensive Care.

Blood ◽

10.1182/blood.v110.11.2860.2860 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2860-2860

Author(s):

Peter Schellongowski ◽

Thomas Staudinger ◽

Klaus Laczika ◽

Gottfried Locker ◽

Andja Bojic ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Prognostic Factors ◽

Respiratory Failure ◽

De Novo ◽

Prognostic Significance ◽

Icu Admission ◽

Saps Ii ◽

Life Threatening ◽

De Novo Aml

Abstract Acute myeloid leukemia (AML) is an acute life-threatening disease with variable clinical presentation. In this study, the percentage of patients (pts) with de novo AML requiring intensive care prior or during induction chemotherapy (ICT), as well as prognostic factors predicting survival in these pts were analyzed. A total of 471 consecutive pts (median age 62 years; range: 16–92) seen at the Vienna University Hospital between 1994–2006 were enrolled. In pts requiring critical care, simplified acute physiology score (SAPS) II as well as the need for invasive mechanical ventilation (IMV), vasopressor support (VP), and disease related markers were recorded at the intensive care unit (ICU). Eighty six percent (n=404) of all patients were eligible for ICT. Fifty four of these 404 patients (13.4%) required critical care prior or during ICT (median SAPS II 64, range 30–107), primarily due to respiratory failure (26 pts=48%) or life-threatening bleeding (12 pts=22%). Comparing ICU and non-ICU-pts with regard to disease-related markers, differences were found in white blood cell counts, WBC (ICU: 16.8 G/L; non-ICU: 11.9 G/L; p=0.084), whereas no differences were found regarding age, plt, and LDH. Forty pts received IMV (63%), and 32 VP (59%). The ICU survival rate was 41%. Significant prognostic factors with respect to ICU-survival were higher SAPS II scores (p<0.05), the need of IMV (p<0.05), and need of VP (p<0.05), whereas CRP, WBC, age, karyotype, or the time of admission to ICU (prior or during ICT) were not of prognostic significance. Survival was favourable in non-ICU-pts (median: 4.14 months; 22% at 8 years) compared to ICU-pts (median: 1.2 months; 9% at 8 years; p<0.05). Similar results were obtained when analyzing the overall survival, OS (non-ICU-pts: median: 4.1 months; 22% at 8 years; ICU-pts: median: 1.6 months; 12% at 8 years; p<0.05). Interestingly, the continuous complete remission, CCR (non-ICU-pts: 37% at 6 years; ICU-pts: 31% at 6 years; p>0.5) as well as OS of patients who had survived the first 28 days of therapy (non-ICU-pts: 29% at 6 years; ICU-pts: 20% at 6 years; p>0.5) did not differ significantly between ICU-pts and non-ICU-pts. With regard to OS, multivariate analysis revealed that ICU admission was an independent adverse prognostic parameter, as was a higher WBC, advanced age, higher LDH, or unfavourable karyotype. With regard to CCR, age and karyotype were independent prognostic variables, whereas ICU-admission was not of prognostic significance. In summary, 13% of pts with de novo AML eligible for ICT required critical care, primarily due to respiratory failure or bleeding. The probability of survival and OS of ICU-pts is inferior compared to non-ICU-pts. However, with regard to CCR and OS of pts surviving 28 days, no differences were observed between ICU-pts and non-ICU-pts. These observations favour the assumption that critical care should be considered in all de novo AML pts eligible for ICT.

Download Full-text

Variation in Utilization of Intensive Care for Pediatric Diabetic Ketoacidosis

Journal of Intensive Care Medicine ◽

10.1177/0885066619868972 ◽

2019 ◽

Vol 35 (11) ◽

pp. 1314-1322

Author(s):

Arpita K. Vyas ◽

Yiu Ming Chan ◽

Lavi Oud

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Intraclass Correlation ◽

Admission Rate ◽

Hospital Charges ◽

Level Variation ◽

Hospital Level ◽

Total Hospital ◽

Icu Admission ◽

Admission Rates

Objective: To examine the hospital-level variation in intensive care unit (ICU) utilization and quantify the relative contribution of patient and hospital characteristics versus individual hospital factors to the variation in ICU admission rates among pediatric hospitalizations with diabetic ketoacidosis (DKA). Methods: The Texas Inpatient Public Use Data File was used to identify hospitalizations of state residents aged 1 month to 19 years with a primary diagnosis of DKA between 2005 and 2014. Multilevel, mixed-effects logistic regression modeling was performed to examine the association of patient- and hospital-level factors with ICU admission. Risk and reliability adjustment was then performed to assess hospital-level variation in ICU utilization. Intraclass correlation coefficient was used to quantify variation in use of ICU attributable to individual hospitals. The association between adjusted rates of ICU admission and total hospital charges and length of stay was examined using linear regression. Results: Of the 23 585 DKA hospitalizations, 14 638 (62.1%) were admitted to ICU. On multilevel analysis, the odds of ICU admission progressively decreased with rising volume of DKA hospitalizations (adjusted odds ratio: 0.08 [highest vs lowest quartile]; 95% confidence interval [CI]: 0.03-0.24). The crude median (interquartile range [IQR]; range) of ICU admissions across hospitals was 82.6% (73%-90%; 11.1%-100%). The median (IQR) risk- and reliability-adjusted ICU admission rate was 81.0% (73.0%-86.9%), ranging from 11.2% to 94%. Following risk and reliability adjustment, the intraclass correlation coefficient was 0.005 (95% CI: 0.004-0.006). For each 10% increase in adjusted ICU admission rate, total hospital charges rose by 7% (95% CI: 3%-11%). There was no association between ICU admission rates and hospital length of stay. Conclusion: Although high variation in ICU utilization was noted across hospitals among pediatric DKA hospitalizations, the proportion of variation attributable to individual hospitals was negligible, once adjusted for patient mix and hospital characteristics.

Download Full-text

Intensive Care Unit and Hospital Outcomes of Patients Admitted with Blastomycosis: A 14-Year Retrospective Study

10.21203/rs.3.rs-220663/v1 ◽

2021 ◽

Author(s):

Yahya Almodallal ◽

Adham K Alkurashi ◽

Hasan Ahmad Hasan Albitar ◽

Hussam Jenad ◽

Suartcha Prueksaritanond ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Distress Syndrome ◽

Clinical Presentation ◽

Admission Rate ◽

Icu Admission ◽

Life Threatening

Abstract Introduction: Blastomycosis is an uncommon; potentially life threatening granulomatous fungal infection. The aim of this study is to report hospital and intensive care unit (ICU) outcomes of patients admitted with blastomycosis. Methods: All patients admitted for treatment of blastomycosis at the Mayo Clinic-Rochester, Minnesota between 01/01/2006 and 09/30/2019 were included. Demographics, comorbidities, clinical presentation, ICU admission, and outcomes were reviewed.Results: A total of 84 Patients were identified with 93 unique hospitalizations primarily for blastomycosis. The median age at diagnosis was 49 (IQR 28.1-65, range: 6-85) years and 56 (66.7%) were male. The most frequent comorbidities included hypertension (n=28, 33.3%); immunosuppressed state (n=25, 29.8%) and diabetes mellitus (n=21, 25%). The lungs were the only organ involved in 56 (66.7%) cases and the infection was disseminated in 19 (22.6%) cases. A total of 29 patients (34.5%) underwent ICU admission due to complications of blastomycosis. ICU related events included mechanical ventilation (n=21, 25%), acute respiratory distress syndrome (ARDS) (n=13, 15.5%), tracheostomy (n=9, 10.7%), renal replacement therapy (n=8, 9.5%), and extracorporeal membrane oxygenation (ECMO) (n=4, 4.8%). A total of 12 patients (14.3%) died in the hospital; all of whom had undergone ICU admission. In-hospital mortality was associated with renal replacement therapy (RRT) (P=0.0255).Conclusions: Blastomycosis is a serious, potentially life-threatening infection that results in significant morbidity and mortality with a 34.5% ICU admission rate. Renal replacement therapy was associated with in-hospital mortality.

Download Full-text

Challenges in the delivery of critical care in India during the COVID-19 pandemic

Journal of the Intensive Care Society ◽

10.1177/1751143720952590 ◽

2020 ◽

pp. 175114372095259

Author(s):

Bharath Kumar Tirupakuzhi Vijayaraghavan ◽

Sheila Nainan Myatra ◽

Meghena Mathew ◽

Nirmalyo Lodh ◽

Jigeeshu Vasishtha Divatia ◽

...

Keyword(s):

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Tract ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Upper Respiratory Tract ◽

Care Services ◽

Life Threatening ◽

Upper Respiratory

Coronavirus disease 2019 cases in India continue to increase and are expected to peak over the next few weeks. Based on some projection models, India is expected to have more than 10 million cases by September 2020. The spectrum of disease can vary from mild upper respiratory tract symptoms to life-threatening acute respiratory distress syndrome and multi-organ failure requiring intensive care. Even if less than 5% of patients require critical care services, this will still rapidly overwhelm the healthcare system in a country, where intensive care services and resources are scarce and unevenly distributed. In this perspective article, we highlight the critical care preparedness of India for the pandemic and the associated challenges.

Download Full-text

Outcome and Prognostic Factors in Patients with Hematological Malignancy That Are Admitted to the Intensive Care Unit.

Blood ◽

10.1182/blood.v104.11.5285.5285 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5285-5285

Author(s):

Christelle Ferra ◽

Maite Misis ◽

Albert Oriol ◽

Pilar Marcos ◽

Natalia Lloveras ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Intensive Care ◽

Hematological Malignancies ◽

Hematological Malignancy ◽

Icu Admission ◽

Life Threatening ◽

Discharged Patients ◽

Life Threatening Complication

Abstract When patients with hematological malignancies develop a life-threatening complication there may be reluctance to admit them in intensive care units (ICU) because of their supposed poor prognosis. The objective of this study was to evaluate the mortality during the ICU admission, the long-term survival, and the prognostic factors that contribute to the survival of patients with hematological malignancies who were transferred to ICU due to a life-threatening complication. From January 2000 to May 2004, the variables at admission and during stay at the ICU, and the follow-up were reviwed in 58 consecutive critically-ill patients with a hematological malignancy from a single institution. The median age (range) was 55 (15–75) years and the male/female ratio was: 38/20. The hematological underlying diseases were: NHL (18 patients), AML (10), ALL (9), MM (6), chronic lymphoproliferative disorder (5), chronic myeloproliferative disorder (4), myelodysplastic syndrome (3), aplastic anemia (2) and Hodgkin’s lymphoma (1). Seven patients had received a hematopoietic stem cell transplant prior to the ICU admission. The main life-threatening acute illness precipitating the ICU transfer were: septic shock (26 patients, 45%), respiratory failure (21, 36%), non-septic hemodynamic instability (5, 9%), respiratory arrest related to a neurological event (2, 3%), post-surgical status (2, 3%), cardiac infarction (1, 2%) and polytrauma (1, 2%). Twenty-one patients (36%) could be discharged alive from the ICU. The median overall survival (range) for ICU discharged patients was 23 (0–54) months, with a median follow-up of 8 months. The actuarial probability of discharged patients to be alive was 56% (CI 95%: 31–75) at 6 months, and a 48% (CI 95%: 13–70) at 12 months. The mean Acute Physiology and Chronic Health Evaluation II (APACHE) score at admission, neutropenia, need for mechanical ventilation, maximum FIO2 requirements at 24 hours from admission, presence of septic shock, renal impairment or liver damage, were associated with a poor outcome in the univariate analysis. A documented infection was not associated with a higher mortality rate except for fungal infection. The APACHE II score at 48 and 72 hours of ICU admission decreased both in surviving and non-surviving patients due to therapeutic manoeuvres and was not predictive of the outcome. The type of the hematological malignancy, its prognosis and the presence of active disease at ICU admission did not predict patients outcome in our series. The number of failing organs also predicted a poorer survival for patients with more than two failing organs (p=0.038). In a multivariate logistical regression model, only the cardiovascular failure requiring vasoactive and the need of mechanical ventilation predicted outcome in the ICU admitted patients diagnosed with a hematological malignancy. A high proportion of admitted patients with a life-threatening complication and a hematological malignancy could be discharged from ICU. Although the mortality rate immediately after ICU discharge was high, those patients that survived the first week outside ICU had an expected survival only conditioned by their hematological malignancy.

Download Full-text

COVID-19 Infection in Children: Estimating Pediatric Morbidity and Mortality

10.1101/2020.05.05.20091751 ◽

2020 ◽

Cited By ~ 2

Author(s):

Michelle Barton ◽

Kayur Mehta ◽

Kriti Kumar ◽

Jielin Lu ◽

Nicole Le Saux ◽

...

Keyword(s):

Admission Rate ◽

Morbidity And Mortality ◽

True Incidence ◽

Icu Admission ◽

Admission Rates ◽

Combining Data ◽

Adults And Children ◽

Government Websites ◽

Age Range ◽

Pediatric Morbidity

ABSTRACTBACKGROUNDEstimates of pediatric morbidity and mortality from COVID-19 are vital for planning optimal use of human and material resources throughout this pandemic.METHODSGovernment websites from countries with minimum 1000 cases in adults and children on April 13, 2020 were searched to find the number of cases confirmed in children, the age range, and the number leading to hospitalization, intensive care unit (ICU) admission or death. A systematic literature search was performed April 13, 2020 to find additional data from cases series.RESULTSData on pediatric cases were available from government websites for 23 of the 70 countries with minimum 1000 cases by April 13, 2020. Of 424 978 cases in these 23 countries, 8113 (1.9%) occurred in children. Nine publications provided data from 4251 cases in 4 additional countries. Combining data from the websites and the publications, 330 of 2361 cases required admission (14%). The ICU admission rate was 2.2 % of confirmed cases (44 of 2031) and 7.2% of admitted children (23 of 318). Death was reported for 15 cases.CONCLUSIONChildren accounted for 1.9% of confirmed cases. The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms. Admission rates vary from 0.3 to 10% of confirmed cases (presumably varying with the threshold for testing) with about 7% of admitted children requiring ICU care. Death is rare in middle and high income countries.

Download Full-text

High dependency and intensive care

10.1093/med/9780198713333.003.0030 ◽

2016 ◽

Author(s):

Philip Barclay ◽

Helen Scholefield

Keyword(s):

Critical Care ◽

Intensive Care ◽

Admission Rate ◽

Severity Of Illness ◽

Scoring Systems ◽

Near Misses ◽

High Dependency ◽

Level 3 ◽

Level 2 ◽

In Pregnancy

The development of maternal critical care is essential in reducing morbidity and mortality due to a substandard level of care. The level of critical care should depend upon the patient’s severity of illness, not their physical location. Escalation to level 3 (intensive) care is uncommon in pregnancy, with a median admission rate of 2.7 per 1000 births, mainly due to hypertensive disorders of pregnancy and haemorrhage. Maternal ‘near misses’ occur more frequently, with 6.5 per 1000 births meeting Mantel’s criteria, of which 85% is due to major obstetric haemorrhage. The admission rate to maternal high dependency units (level 2 care) varies from 1% to 5%. Acute physiological scoring systems have been found to be reliable when applied to parturients receiving level 3 care but overestimate mortality. Maternal early warning scores have been derived from simplified versions of these systems, with allowance made for physiological changes seen in pregnancy. There are many different maternity scoring systems in use throughout England and Wales. All share the same principle that parameters should be recorded regularly during the hospital stay, with deviations from normal quantified, recorded, and acted upon. A chain of response is then required to ensure that suitably qualified staff, possessing appropriate critical care competencies, attend in a timely fashion. Appropriate resources must be available with equipment readily to hand and suitably trained staff so that invasive monitoring can be used. Clear admission criteria are required for level 2 care within the delivery suite and escalation to level 3, with suitable arrangements for transfer.

Download Full-text

Variability in intensive care unit admission among pregnant and postpartum women in Canada: a nationwide population-based observational study

Critical Care ◽

10.1186/s13054-019-2660-x ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 3

Author(s):

Kazuyoshi Aoyama ◽

Ruxandra Pinto ◽

Joel G. Ray ◽

Andrea D. Hill ◽

Damon C. Scales ◽

...

Keyword(s):

Maternal Morbidity ◽

Admission Rate ◽

Population Based ◽

Severe Maternal Morbidity ◽

Income Quintile ◽

Postpartum Women ◽

Logistic Regression Models ◽

Icu Admission ◽

Admission Rates ◽

Total Variability

Abstract Background Pregnancy-related critical illness results in approximately 300,000 deaths globally each year. The objective was to describe the variation in ICU admission and the contribution of patient- and hospital-based factors in ICU admission among acute care hospitals for pregnant and postpartum women in Canada. Methods A nationwide cohort study between 2004 and 2015, comprising all pregnant or postpartum women admitted to Canadian hospitals. The primary outcome was ICU admission. Secondary outcomes were severe maternal morbidity (a potentially life-threatening condition) and maternal death (during and within 6 weeks after pregnancy). The proportion of total variability in ICU admission rates due to the differences among hospitals was described using the median odds ratio from multi-level logistic regression models, adjusting for individual hospital clusters. Results There were 3,157,248 identifiable pregnancies among women admitted to 342 Canadian hospitals. The overall ICU admission rate was 3.2 per 1000 pregnancies. The rate of severe maternal morbidity was 15.8 per 1000 pregnancies, of which 10% of women were admitted to an ICU. The most common severe maternal morbidity events included postpartum hemorrhage (n = 16,364, 0.52%) and sepsis (n = 11,557, 0.37%). Of the 195 maternal deaths (6.2 per 100,000 pregnancies), only 130 (67%) were admitted to ICUs. Patients dying in hospital, without admission to ICU, included those with cardiovascular compromise, hemorrhage, and sepsis. For 2 pregnant women with similar characteristics at different hospitals, the average (median) odds of being admitted to ICU was 1.92 in 1 hospital compared to another. Hospitals admitting the fewest number of pregnant patients had the highest incidence of severe maternal morbidity and mortality. Patient-level factors associated with ICU admission were maternal comorbidity index (OR 1.88 per 1 unit increase, 95%CI 1.86–1.99), urban residence (OR 1.09, 95%CI 1.02–1.16), and residing at the lowest income quintile (OR 1.44, 95%CI 1.34–1.55). Conclusions Most women who experience severe maternal morbidity are not admitted to an ICU. There exists a wide hospital-level variability in ICU admission, with patients living in urban locations and patients of lowest income levels most likely to be admitted to ICU. Cardiovascular compromise, hemorrhage, and sepsis represent an opportunity for improved patient care and outcomes.

Download Full-text

Predictors of Mortality in Patients Undergoing Autologous Stem Cell Transplant (ASCT) Admitted to the Intensive Care Unit: An Institutional Review of 1013 Transplant Patients over Five Years.

Blood ◽

10.1182/blood.v110.11.2876.2876 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2876-2876

Author(s):

Martina A. Trinkaus ◽

Stephen E. Lapinsky ◽

David C. Hallett ◽

Norman Franke ◽

Andrew Winter ◽

...

Keyword(s):

Intensive Care Unit ◽

Multiple Myeloma ◽

Mechanical Ventilation ◽

Intensive Care ◽

Febrile Neutropenia ◽

Organ Failure ◽

Admission Rate ◽

Apache Ii ◽

Gram Negative ◽

Icu Admission

Abstract Study Objective: To describe the outcomes of ASCT recipients transferred to the Intensive Care Unit (ICU), and identify predictors for mortality. Methods: Retrospective review of all ASCT recipients from Jan 2001-July 2006 who required ICU transfer up to 100 days post ASCT. Measurements and main Results: Thirty-four of 1013 patients (3.3%) who underwent ASCT, were admitted to the ICU. The mean age at admission was 54.9 +/− 11.1 (range 28–71), 53% being female. Indications for ASCT included multiple myeloma (50%), amyloidosis (32%), or other malignancies (18%). Table 1 highlights the admission rate to the ICU by diagnosis. The primary admitting diagnosis in the ICU included sepsis (32%), cardiac related events (26%), or respiratory compromise (29%). Median days post ASCT was 10.0 days with a median in ICU stay of 4.0 days (range 1–37 days). Twenty patients (including all non-survivors) required mechanical ventilation for > 24 hours with a median duration of 3.0 days. Thirteen patients died (38%) in the ICU, with 11 dying of multi-system organ failure and 2 from cardiac arrest. Retrospectively collected parameters restricted to the first 24 hours of admission revealed that Sequential Organ Failure Assessment (SOFA) score (OR 1.30; CI95 1.09–1.64, P=0.003) and Acute Physiology and Chronic Health Evaluation (APACHE II) score (OR 1.43; CI95 1.14–2.16; P=0.0002) were statistically associated with mortality in univariate analysis. The variables predictive of mortality at 24 hours after admission are displayed in Table 2. Conclusion: ICU admission is uncommon, occuring in 3% of patients undergoing ASCT, of which 38% die (1% of total ASCTs). Admission is influenced by underlying diagnosis, with amyloid patients portending the highest risk. Mortality in ASCT patients admitted to the ICU can be predicted in the first 24 hours by specific assessment scores (SOFA and APACHE II); specific supportive care requirements: inotropic dependence, hemodialysis, and need for ventilation; and clinical findings of gram negative sepsis or > 2 organ failure. Patients with febrile neutropenia had a low risk of mortality (possibly due to aggressive antibiotic use, growth factors, and rapid engraftment post ASCT). These results may assist clinical decision making regarding the continuation of intensive care delivered 24 hours after admission. Percentage Admission Rate by Diagnosis (n = 1013) Diagnosis ASCT (#) ICU Admission (#)/ (%) Non-survivors (#) Multiple Myeloma 615 17 / (2.8%) 6 Non-Hodgkin’s Lymphoma 199 2/ (1.0%) 1 Hodgkin’s Lymphoma 112 1 / (0.9%) 0 Amyloidosis 39 11/ (28.2%) 6 Acute Myeloid Leukemia 17 1/ (5.9%) 0 Other (Germ Cell Tumour, Waldenstrom’s Macroglobuliemia, POEMS) 31 2/ (6.4%) 0 Variables Predictive of Mortality at 24 hours after Admission Variable Predictors Number of Patients Survivors (n = 21) Non-survivors (n = 13) P-value Febrile Neutropenia 15 13 (62%) 2 (15%) 0.013 Failure of > 2 organs 20 9 (43%) 11 (85%) 0.030 Mechanical Ventilation 20 9 (43%) 11 (85%) 0.030 Inotropic Support > 4 hours 10 3 (14%) 7 (54%) 0.022 Hemodialysis 12 4 (19%) 8 (62%) 0.025 Gram Negative Infection 6 1 (5%) 5 (42%) 0.016

Download Full-text

Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2014.47 ◽

2014 ◽

Vol 8 (4) ◽

pp. 326-332 ◽

Cited By ~ 7

Author(s):

Ari M. Lipsky ◽

Yoram Klein ◽

Adi Givon ◽

Moti Klein ◽

Jeffrey S. Hammond ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Trauma Patients ◽

Likelihood Ratios ◽

Icu Admission ◽

Number Of Patients ◽

Definition Of ◽

Sensitivity Specificity ◽

Blast Trauma ◽

Injured Patients

ABSTRACTObjectiveWe investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.MethodsWe conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.ResultsA total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.ConclusionsTriage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (Disaster Med Public Health Preparedness. 2014;0:1–7)

Download Full-text