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.

Sportliche Leistung von Pferden, die als Fohlen intensivmedizinischer Behandlung bedurften

2019 ◽  
Vol 47 (06) ◽  
pp. 399-399
Author(s):  
Lukas Demattio
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sich Eine ◽  
Factors Associated ◽  
Intensivmedizinische Behandlung ◽  
Sportliche Leistung

Studies AC, Chidlow H, Ere SG et al. Factors associated with long-term athletic outcome in Thoroughbred neonates admitted to an intensive care unit. Equine Vet J 2019; 51: 716–719 Für viele Pferdezüchter stellt sich immer wieder die Frage, wie viel Geld in ein Fohlen investiert werden soll, wenn dieses tierärztlicher Behandlung bedarf. Lohnt sich eine intensivmedizinische Behandlung für ein Fohlen, das für eine sportliche Nutzung vorgesehen ist? Diese Frage versuchten die Autoren in der Studie zu beantworten.

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 Severity of acidosis affects long-term survival in COPD patients with hypoxemia after intensive care unit discharge

2018 ◽  
Vol Volume 13 ◽  
pp. 1495-1506 ◽  
Author(s):  
Sinem Gungor ◽  
Feyza Kargin ◽  
Ilim Irmak ◽  
Fulya Ciyiltepe ◽  
Eylem Acartürk Tunçay ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Discharge ◽  
Term Survival ◽  
Unit Discharge ◽  
Long Term Survival ◽  
Copd Patients

Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection

2006 ◽  
Vol 34 (2) ◽  
pp. 354-362 ◽  
Author(s):  
H A. Cense ◽  
J B. F. Hulscher ◽  
A G. E. M. de Boer ◽  
D A. Dongelmans ◽  
H W. Tilanus ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Esophageal Resection ◽  
Term Survival ◽  
Long Term Survival

Patients’ Characteristics Associated With Readmission to a Surgical Intensive Care Unit

2012 ◽  
Vol 21 (6) ◽  
pp. e120-e128 ◽  
Author(s):  
T. K. Timmers ◽  
M. H. J. Verhofstad ◽  
K. G. M. Moons ◽  
L. P. H. Leenen
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Severity Of Illness ◽  
Total Sample ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Term Survival

Background Readmission within 48 hours is a leading performance indicator of the quality of care in an intensive care unit. Objective To investigate variables that might be associated with readmission to a surgical intensive care unit. Methods Demographic characteristics, severity-of-illness scores, and survival rates were collected for all patients admitted to a surgical intensive care unit between 1995 and 2000. Long-term survival and quality of life were determined for patients who were readmitted within 30 days after discharge from the unit. Quality of life was measured with the EuroQol-6D questionnaire. Multivariate logistic analysis was used to calculate the independent association of expected covariates. Results Mean follow-up time was 8 years. Of the 1682 patients alive at discharge, 141 (8%) were readmitted. The main causes of readmission were respiratory decompensation (48%) and cardiac conditions (16%). Compared with the total sample, patients readmitted were older, mostly had vascular (39%) or gastrointestinal (26%) disease, and had significantly higher initial severity of illness (P = .003, .007) and significantly more comorbid conditions (P = .005). For all surgical classifications except general surgery, readmission was independently associated with type of admission and need for mechanical ventilation. Long-term mortality was higher among patients who were readmitted than among the total sample. Nevertheless, quality-of-life scores were the same for patients who were readmitted and patients who were not. Conclusion The adverse effect of readmission to the intensive care unit on survival appears to be long-lasting, and predictors of readmission are scarce.

Single Centre Experience of Patients with Haematological Malignancies Admitted to Intensive Care Unit: A Comparative Review of Allogenic Bone Marrow Transplant Data.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1830-1830
Author(s):  
Zi Yi Lim ◽  
Jane Graham ◽  
Sylvia Simpson ◽  
Stephen Devereux ◽  
Antonio Pagliuca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Overall Survival ◽  
Intensive Care ◽  
Inotropic Support ◽  
Haematological Malignancies ◽  
Term Survival ◽  
Icu Admission ◽  
Icu Outcome ◽  
Reduced Intensity

Abstract Introduction: Previous studies have indicated that the prognosis of patients with haematological malignancies who are admitted to intensive care unit (ICU) is poor. In particular, it has been suggested that the mortality for allogenic BMT patients requiring ICU admission is particularly high. The recent increased usage of reduced intensity conditioning has allowed allogenic transplantation of older patients who would previously be unsuitable for BMT. It is however unclear as to whether these patients may have a better ICU outcome. Methods: A retrospective review was performed of all haemato-oncology admissions to Kings College Hospital from May 2000 to Apr 2004 who were subsequently admitted to ICU. Information was collected from all patients for demographic factors, haematological status, APACHE score, organ dysfunction, microbiological data, and supportive organ therapy at point of admission to and during ICU stay. All variables were evaluated for prognostic relevance by univariate and multivariate analyses. Post-ICU survival was examined at day 30 and 1 year. Results: There were a total of 1249 admissions during the study period, of which 330(26.4%) were BMT patients. 57 ICU admissions (55 patients) were documented, 31 non-BMT (3.3%) vs 26 BMT (8.5%). The diagnoses were AML/MDS 26 (47.3%), ALL 6 (10.9%), NHL/HD 14 (25.5%), myeloma 5 (9.1%), others 4 (7.2%). Amongst post BMT patients, type of conditioning received was: reduced intensity 50%(13), standard myeloablative 34.6%(9), autologous 15.3%(4). 14 patients were early admissions within 6 months of BMT. The main cause of admission to ICU was due to chest sepsis with acute hypoxaemia. Conventional mechanical ventilation (MV) was used in 43(72.9%) of patients, and non-invasive MV in 16(27.1%). 30(50.8%) of patients received inotropic support during their ICU admission. Main cause of death was due to acute respiratory distress syndrome. There was no significant difference in age, duration of ICU admission and mechanical ventilation between non-BMT and BMT patients. However, the BMT group had higher numbers of myeloid malignancies, neutropenia, and intropic support. Overall ICU survival for the entire group, non-BMT, allogenic BMT (myeloablative + RIC) patients was 29.8%, 32.3% and 27.3% respectively. Kaplan-Meier estimation of longer term survival for these three groups at 30 day and 12 months was 23.7% and 14.6%, 20.1% and 10.9%, 24.3% and 19.5% respectively. The overall survival between these patient groups was not significant (p-value 0.757). Sub-analysis of RIC BMT data for 30 day and 1 year outcome was 35.8% and 29.3%, none of the 9 myeloablative patients survived beyond day 30. Univariate analysis identified intropic support, renal failure (creatinine >150), thrombocytopenia (platelet < 50) as significant variables for increased mortality (p-values 0.005, 0.012, 0.007 respectively). Results of multivariate analysis showed that inotropic support, was the only independant factor associated with increased ICU mortality. Estimated 30 day and 1 year survival for patients receiving vs not receiving inotropic support was 8% vs 39% and 6% vs 24%. Conclusion: Our data demonstrates that the admission of haemato-oncology patients to ICU can be associated with a favourable outcome. Significantly, in our cohort the overall survival of allogenic BMT patients was comparable with non-BMT patients. In addition, RIC patients appear to have a good ICU outcome and longer term survival.

Outcomes and Prognostic Factors for Patients with Acute Myeloid Leukemia Admitted to the Intensive Care Unit

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3613-3613
Author(s):  
Kathryn A Jackson ◽  
Peter Mollee ◽  
Kirk Morris ◽  
Dwane L Jackson ◽  
Peter Kruger ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prognostic Factors ◽  
Hospital Discharge ◽  
Myeloid Leukemia ◽  
Intensive Chemotherapy ◽  
Consolidation Chemotherapy ◽  
Term Survival ◽  
Icu Admission ◽  
Acute Myeloid

Abstract Abstract 3613 Aim Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy commonly experience life-threatening complications requiring intensive care unit (ICU) support. Limited information is available regarding which patients are likely to benefit from an ICU admission and their subsequent outcomes. The present study has considered a more homogenous patient population than the majority of previous reports of ICU outcomes in AML, as patients were only included if they were within an induction or consolidation chemotherapy cycle for recently-diagnosed AML. Methods This is a retrospective study of 505 consecutive adult patients with newly-diagnosed AML who were treated at the Royal Brisbane or Princess Alexandra Hospitals with intensive chemotherapy between 1st January 1999 and 31st December 2010. Hematology and ICU databases were cross-referenced to identify patients admitted to ICU in the setting of intensive induction or consolidation chemotherapy attempting to achieve or maintain complete remission 1 (CR1). Statistical analyses were undertaken to identify risk factors for ICU admission, short- and long-term outcomes, and prognostic factors predicting survival following ICU admission. Results Eighty-three patients (16.4%) were identified who had required a total of 92 ICU admissions, complicating 9.4% of induction and 6.7% of consolidation chemotherapy cycles. The median age of patients admitted to ICU was 53 years. Neutropenia was present in 70.7% of patients on admission to ICU, with a median duration of 13 days. The primary indication for ICU admission was hemodynamic instability in 46.7% of patients and respiratory impairment in 40.2% of patients; the underlying pathology was most commonly infection (75.0%). Vasopressors were required in 67.4% of admissions, mechanical ventilation in 58.7%, and hemodialysis in 15.2%. Median APACHE III score was 89 and SOFA score was 11. There were no baseline characteristics found to be associated with an increased likelihood of ICU admission during chemotherapy. Survival to ICU discharge, hospital discharge, 6 months, and 12 months were 67.4%, 60.9%, 48.9%, and 38.6%, respectively. Patients admitted to ICU had worse overall survival than patients not requiring ICU admission (median OS = 0.7 years vs 3.5 years, 5 year OS = 24.3% vs 46.0%, respectively; P < 0.0001) (Figure 1). The increased mortality was predominantly the result of early deaths, as ICU patients surviving to hospital discharge had a similar long-term survival to other patients who survived chemotherapy (median OS = 6.7 years vs 4.1 years, 5 year OS 38.0% vs 47.8%; P = 0.83) (Figure 2). Leukemia-free survival from the time of CR1 was not significantly different between groups (P = 0.054). Multivariate analysis identified independent prognostic factors predicting mortality prior to hospital discharge to be mechanical ventilation use and higher fibrinogen, and mortality at 12 months to be associated with mechanical ventilation use and AML cytogenetic risk group. Notably, survival in patients admitted to ICU was not significantly influenced by the AML status (active disease vs CR1), whether the patient was receiving an induction or consolidation cycle, or the dose of cytarabine used. Conclusions Admission to ICU is associated with an increased mortality rate compared to those patients not requiring ICU admission. However, a substantial proportion of patients recover from the acute event, and subsequently experience long-term survival. Prognostic factors predicting short-term survival tend to be related to the acute illness, while longer-term survival is more significantly affected by characteristics of the underlying AML. No factors predicted an outcome sufficiently poor to indicate futility of ICU care. Disclosures: No relevant conflicts of interest to declare.

Long-term survival after intensive care unit admission with sepsis

1995 ◽  
Vol 23 (6) ◽  
pp. 1040-1047 ◽  
Author(s):  
Kent C. Sasse ◽  
Eric Nauenberg ◽  
Alan Long ◽  
Bette Anton ◽  
Harvey J. Tucker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Term Survival ◽  
Long Term Survival
Sign in / Sign up

Export Citation Format

Share Document