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Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain.


ABSTRACT: PURPOSE:To estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients. METHODS:We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high (2+, 1 or 0 empty beds). This instrumental variable (IV) analysis was repeated for the subgroup of referrals with a recommendation for critical care once assessed. Risk-adjusted 90-day survival models were also constructed. RESULTS:A total of 12,380 patients from 48 hospitals were available for analysis. There were 2411 (19%) prompt admissions (median delay 1 h, IQR 1-2) and 9969 (81%) controls; 1990 (20%) controls were admitted later (median delay 11 h, IQR 6-26). Prompt admissions were less frequent (p?

SUBMITTER: Harris S 

PROVIDER: S-EPMC6006241 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain.

Harris Steve S   Singer Mervyn M   Sanderson Colin C   Grieve Richard R   Harrison David D   Rowan Kathryn K  

Intensive care medicine 20180507 5


<h4>Purpose</h4>To estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients.<h4>Methods</h4>We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high  ...[more]

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