Dataset Information

Hospital mortality is associated with ICU admission time.

ABSTRACT:

Introduction

Previous studies have shown that patients admitted to the intensive care unit (ICU) after "office hours" are more likely to die. However these results have been challenged by numerous other studies. We therefore analysed this possible relationship between ICU admission time and in-hospital mortality in The Netherlands.

Methods

This article relates time of ICU admission to hospital mortality for all patients who were included in the Dutch national ICU registry (National Intensive Care Evaluation, NICE) from 2002 to 2008. We defined office hours as 08:00-22:00 hours during weekdays and 09:00-18:00 hours during weekend days. The weekend was defined as from Saturday 00:00 hours until Sunday 24:00 hours. We corrected hospital mortality for illness severity at admission using Acute Physiology and Chronic Health Evaluation II (APACHE II) score, reason for admission, admission type, age and gender.

Results

A total of 149,894 patients were included in this analysis. The relative risk (RR) for mortality outside office hours was 1.059 (1.031-1.088). Mortality varied with time but was consistently higher than expected during "off hours" and lower during office hours. There was no significant difference in mortality between different weekdays of Monday to Thursday, but mortality increased slightly on Friday (RR 1.046; 1.001-1.092). During the weekend the RR was 1.103 (1.071-1.136) in comparison with the rest of the week.

Conclusions

Hospital mortality in The Netherlands appears to be increased outside office hours and during the weekends, even when corrected for illness severity at admission. However, incomplete adjustment for certain confounders might still play an important role. Further research is needed to fully explain this difference.

SUBMITTER: Kuijsten HA

PROVIDER: S-EPMC2940016 | biostudies-literature | 2010 Oct

REPOSITORIES: biostudies-literature

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Publications

Hospital mortality is associated with ICU admission time.

Kuijsten Hans A J M HAJM Brinkman Sylvia S Meynaar Iwan A IA Spronk Peter E PE van der Spoel Johan I JI Bosman Rob J RJ de Keizer Nicolette F NF Abu-Hanna Ameen A de Lange Dylan W DW

Intensive care medicine 20100615 10

<h4>Introduction</h4>Previous studies have shown that patients admitted to the intensive care unit (ICU) after "office hours" are more likely to die. However these results have been challenged by numerous other studies. We therefore analysed this possible relationship between ICU admission time and in-hospital mortality in The Netherlands.<h4>Methods</h4>This article relates time of ICU admission to hospital mortality for all patients who were included in the Dutch national ICU registry (Nationa ...[more]

PMID: 20549184

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Project description:The Surviving Sepsis Campaign Guidelines 2021 recommends that adult patients with sepsis requiring intensive care should be admitted to the ICU within 6 hours of their emergency department (ED) visits. However, there is limited evidence on whether 6 hours is the best target time for compliance with the sepsis bundle. We aimed to investigate the association between time from ED visits to ICU admission (i.e., ED length of stay [ED-LOS]) and mortality and identify the optimal ED-LOS for patients with sepsis.DesignRetrospective cohort study.SettingThe Medical Information Mart for Intensive Care Emergency Department and Medical Information Mart for Intensive Care IV databases.PatientsAdult patients (≥ 18 yr old) who were transferred from the ED to the ICU and subsequently diagnosed with sepsis based on the Sepsis-3 criteria within 24 hours of ICU admission.InterventionsNone.Measurements and main resultsAmong 1,849 patients with sepsis, we found a disproportionally higher mortality rate in patients immediately admitted to the ICU (e.g., < 2 hr). When using ED-LOS as a continuous variable, ED-LOS was not significantly associated with 28-day mortality (adjusted odds ratio [OR] per hour increase, 1.04; 95% CI, 0.96-1.13; p = 0.3) after an adjustment for potential confounders (e.g., demographics, triage vital signs, and laboratory results) in the multivariable analysis. However, when we categorized all patients into time quartiles (ED-LOS: < 3.3 hr, 3.3-4.5 hr, 4.6-6.1 hr, and > 6.1 hr), patients in the higher time quartiles (e.g., 3.3-4.5 hr) had higher 28-day mortality compared with those in the lowest time quartile (< 3.3 hr) (e.g., adjusted OR for patients in the second time quartile [3.3-4.5 hr] 1.59; 95% CI, 1.03-2.46; p = 0.04).ConclusionsEarlier admission to the ICU (e.g., within 3.3 hr of ED visits) was associated with lower 28-day mortality in patients with sepsis. Our findings suggest patients with sepsis who require intensive care may benefit from a more immediate ICU admission than 6 hours.

Dataset Information

Hospital mortality is associated with ICU admission time.

Introduction

Methods

Results

Conclusions

Publications

Hospital mortality is associated with ICU admission time.

Similar Datasets

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