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Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study.

Capuzzo, M; Volta, C; Tassinati, T; Moreno, R; Valentin, A; Guidet, B; Iapichino, G; Martin, C; Perneger, T; Combescure, C; et al. Capuzzo, M; Volta, C; Tassinati, T; Moreno, R; Valentin, A; Guidet, B; Iapichino, G; Martin, C; Perneger, T; Combescure, C; Poncet, A; Rhodes, A; Working Group on Health Economics of the European Society of Int (2014) Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study. Crit Care, 18 (5). p. 551. ISSN 1466-609X https://doi.org/10.1186/s13054-014-0551-8
SGUL Authors: Rhodes, Andrew

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Abstract

INTRODUCTION: The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU. METHODS: An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days). RESULTS: One hundred and sixty-seven 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, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P <0.001). After adjustment for patient characteristics at admission such as illness severity, and ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002). CONCLUSIONS: The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment. TRIAL REGISTRATION: Clinicaltrials.gov NCT01422070. Registered 19 August 2011.

Item Type: Article
Additional Information: © Capuzzo et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Aged, Aged, 80 and over, Cohort Studies, Europe, Female, Hospital Mortality, Hospitals, Humans, Intensive Care Units, Intermediate Care Facilities, Male, Middle Aged, Patient Admission, Working Group on Health Economics of the European Society of Intensive Care Medicine, Humans, Patient Admission, Hospital Mortality, Cohort Studies, Aged, Aged, 80 and over, Middle Aged, Intensive Care Units, Hospitals, Intermediate Care Facilities, Europe, Female, Male, Emergency & Critical Care Medicine, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Crit Care
ISSN: 1466-609X
Language: eng
Dates:
DateEvent
9 October 2014Published
23 September 2014Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 25664865
Web of Science ID: WOS:000351850600067
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107551
Publisher's version: https://doi.org/10.1186/s13054-014-0551-8

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