Dataset Information

Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study.

ABSTRACT:

Objective

To evaluate whether a relation exists between volume and outcome for admissions with severe sepsis to adult general critical care units in the United Kingdom.

Design

Retrospective cohort study using data from a pooled case mix and outcome database.

Setting

Adult general critical care units participating in the case mix programme.

Participants

Consecutive admissions to participating units for the years 2008-09 meeting objective, standardised criteria for severe sepsis.

Main outcome measures

Mortality at ultimate discharge from acute hospital.

Results

The primary exposure was volume of admissions with severe sepsis per unit per year. A multivariable logistic regression analysis, using generalised estimating equations, was used to assess the association between volume, modelled using fractional polynomials, and ultimate acute hospital mortality while adjusting for potential confounders. No relation was seen between volume and outcome for admissions with severe sepsis to adult, general critical care units in the UK. Subgroup analyses tested for interactions between the effect of volume and acute severity of illness or receipt of mechanical ventilation. No significant interactions were found.

Conclusions

This study showed no relation between volume and outcome in admissions with severe sepsis treated in adult general critical care units in the UK.

SUBMITTER: Shahin J

PROVIDER: S-EPMC3362472 | biostudies-literature | 2012 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study.

Shahin Jason J Harrison David A DA Rowan Kathryn M KM

BMJ (Clinical research ed.) 20120529

<h4>Objective</h4>To evaluate whether a relation exists between volume and outcome for admissions with severe sepsis to adult general critical care units in the United Kingdom.<h4>Design</h4>Retrospective cohort study using data from a pooled case mix and outcome database.<h4>Setting</h4>Adult general critical care units participating in the case mix programme.<h4>Participants</h4>Consecutive admissions to participating units for the years 2008-09 meeting objective, standardised criteria for sev ...[more]

PMID: 22645208

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Project description:IntroductionThe aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis.MethodsA retrospective cohort study was conducted using the database of the Dutch National Intensive Care Evaluation (NICE) registry. Analyses were based on consecutive patients admitted between 1 January 2003 and 30 June 2005 who fulfilled criteria for severe sepsis within the first 24 hours of admission. A 13-item questionnaire was sent to all 32 ICUs across The Netherlands that participated in the NICE registry within this period in order to obtain information on ICU organization and staffing. The association between in-hospital mortality and factors related to ICU organization was investigated using logistic regression analysis, combined with generalized estimation equations to account for potential correlations of outcomes within ICUs. Correction for patient-related factors took place by including Simplified Acute Physiology Score II, age, sex and number of dysfunctioning organ systems in the analyses.ResultsAnalyses based on 4,605 patients from 28 ICUs (questionnaire response rate 90.6%) revealed that a higher annual volume of severe sepsis patients is associated with a lower in-hospital mortality (P = 0.029). The presence of a medium care unit (MCU) as a step-down facility with intermediate care is associated with a higher in-hospital mortality (P = 0.013). For other items regarding ICU organization, no independent significant relationships with in-hospital mortality were found.ConclusionA larger annual volume of patients with severe sepsis admitted to Dutch ICUs is associated with lower in-hospital mortality in this patient group. The presence of a MCU as a step-down facility is associated with greater in-hospital mortality. No other significant associations between in-hospital mortality and factors related to ICU organization were found.

Project description:ObjectiveTo assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom.DesignPopulation based longitudinal cohort study using nationwide clinical registries.Setting and participantsNationwide registry data comprising all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART/RIKS-HIA, n=87; 119,786 patients) and the UK (NICOR/MINAP, n=242; 391,077 patients), 2004-10.Main outcome measuresBetween hospital variation in 30 day mortality of patients admitted with acute myocardial infarction.ResultsCase mix standardised 30 day mortality from acute myocardial infarction was lower in Swedish hospitals (8.4%) than in UK hospitals (9.7%), with less variation between hospitals (interquartile range 2.6% v 3.5%). In both countries, hospital level variation and 30 day mortality were inversely associated with provision of guideline recommended care. Compared with the highest quarter, hospitals in the lowest quarter for use of primary percutaneous coronary intervention had higher volume weighted 30 day mortality for ST elevation myocardial infarction (10.7% v 6.6% in Sweden; 12.7% v 5.8% in the UK). The adjusted odds ratio comparing the highest with the lowest quarters for hospitals' use of primary percutaneous coronary intervention was 0.70 (95% confidence interval 0.62 to 0.79) in Sweden and 0.68 (0.60 to 0.76) in the UK. Differences in risk between hospital quarters of treatment for non-ST elevation myocardial infarction and secondary prevention drugs for all discharged acute myocardial infarction patients were smaller than for reperfusion treatment in both countries.ConclusionBetween hospital variation in 30 day mortality for acute myocardial infarction was greater in the UK than in Sweden. This was associated with, and may be partly accounted for by, the higher practice variation in acute myocardial infarction guideline recommended treatment in the UK hospitals. High quality healthcare across all hospitals, especially in the UK, with better use of guideline recommended treatment, may not only reduce unacceptable practice variation but also deliver improved clinical outcomes for patients with acute myocardial infarction. Clinical trials registration Clinical trials NCT01359033.

Dataset Information

Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study.

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study.

Similar Datasets

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