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Comparative Study
. 2011;15(1):R28.
doi: 10.1186/cc9975. Epub 2011 Jan 18.

Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study

Lucienne T Q Cardoso  1 , Cintia M C Grion, Tiemi Matsuo, Elza H T Anami, Ivanil A M Kauss, Ludmila Seko, Ana M Bonametti
Affiliations
Comparative Study

Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study

Lucienne T Q Cardoso et al. Crit Care. 2011.

Abstract

Introduction: When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients.

Methods: A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, Acute Physiology and Chronic Health Evaluation (APACHE) II score, therapeutic intervention, and Sequential Organ Failure Assessment (SOFA) score. All patients were followed until hospital discharge.

Results: A total of 401 patients were evaluated; 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% to 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio (HR): 1.015; 95% CI 1.006 to 1.023; P = 0.001).

Conclusions: There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes.

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Figures

Figure 1
Figure 1
Flow diagram of patient admissions.
Figure 2
Figure 2
ICU mortality rate among patients grouped by time to ICU admission. This figure shows increase in mortality rate according to ICU waiting time. There is a significant tendency of increase in mortality with time. IA, immediate admission (c2: 9.78; P = 0.002).
See this image and copyright information in PMC

References

    1. Levin PD, Sprung CL. The process of intensive care triage. Intensive Care Med. 2001;27:1441–1445. doi: 10.1007/s001340101042. - DOI - PubMed
    1. Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: Detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999;47:964–969. doi: 10.1097/00005373-199911000-00028. - DOI - PubMed
    1. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999;341:625–634. doi: 10.1056/NEJM199908263410901. - DOI - PubMed
    1. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Br Med J. 2002;324:387–390. doi: 10.1136/bmj.324.7334.387. - DOI - PMC - PubMed
    1. Weaver WD. Time to thrombolytic treatment: Factors affecting delay and their influence on outcome. J Am Coll Cardiol. 1995;25:3S–9S. doi: 10.1016/0735-1097(95)00108-G. - DOI - PubMed

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