Intensive Care Medicine

, Volume 30, Issue 10, pp 1908–1913

The longer patients are in hospital before Intensive Care admission the higher their mortality

  • David R. Goldhill
  • Alistair F. McNarry
  • Vassilis G. Hadjianastassiou
  • Paris P. Tekkis
Original

DOI: 10.1007/s00134-004-2386-2

Cite this article as:
Goldhill, D.R., McNarry, A.F., Hadjianastassiou, V.G. et al. Intensive Care Med (2004) 30: 1908. doi:10.1007/s00134-004-2386-2

Abstract

Objective

To explore the relationship between hospital mortality and time spent by patients on hospital wards before admission to the intensive care unit (ICU).

Design

Observational study of prospectively collected data.

Setting

Participating intensive care units within the North East Thames Regional Database.

Patients and participants

Patients, 7,190, admitted to ICU from the hospital wards of 24 hospitals.

Interventions

None.

Measurements and results

Of ICU admissions from the wards, 40.1% were in hospital for more than 3 days and 11.7% for more than 15 days. ICU patients who died in hospital were in-patients longer (p=0.001) before admission (median 3 days; interquartile range 1–9) than those discharged alive (median 2 days; interquartile range 1–5). Hospital mortality increased significantly (p<0.0001) in relation to time on hospital wards before ICU: 47.1% (standardised mortality ratio 1.09) for patients in hospital 0–3 days before ICU admission up to 67.2% (standardised mortality ratio 1.39) for patients on the wards for more than 15 days before ICU. Length of stay before ICU admission was an independent predictor of hospital mortality (odds ratio per day 1.019; 95% confidence interval 1.014–1.024). There were significant differences (p<0.001) in patient age, APACHE II score and predicted mortality in relation to time on wards before ICU admission.

Conclusions

Mortality was high among patients admitted from the wards to ICU; many were inpatients for days or weeks before admission. The longer these patients were in hospital before ICU admission, the higher their mortality. Patients with delayed admission differed in some respects compared to those admitted earlier.

Keywords

Hospital outcomeInpatient managementPhysiological abnormalitiesPre-ICU care

Supplementary material

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • David R. Goldhill
    • 1
  • Alistair F. McNarry
    • 2
  • Vassilis G. Hadjianastassiou
    • 3
  • Paris P. Tekkis
    • 4
  1. 1.Department of Anaesthesia and Critical Care MedicineThe Royal National Orthopaedic HospitalStanmoreUK
  2. 2.Anaesthetics Unit, The Royal London HospitalBarts and the London NHS TrustLondonUK
  3. 3.Department of Vascular SurgeryUniversity Hospital, LewishamLondonUK
  4. 4.Department of SurgerySt. Mark’s HospitalUK