Update on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research

Abstract

In recent decades, several databases of critically ill patients have become available in both low-, middle-, and high-income countries from all continents. These databases are also rich sources of data for the surveillance of emerging diseases, intensive care unit performance evaluation and benchmarking, quality improvement projects and clinical research. The Epimed Monitor database is turning 15 years old in 2024 and has become one of the largest of these databases. In recent years, there has been rapid geographical expansion, an increase in the number of participating intensive care units and hospitals, and the addition of several new variables and scores, allowing a more complete characterization of patients to facilitate multicenter clinical studies. As of December 2023, the database was being used regularly for 23,852 beds in 1,723 intensive care units and 763 hospitals from ten countries, totaling more than 5.6 million admissions. In addition, critical care societies have adopted the system and its database to establish national registries and international collaborations. In the present review, we provide an updated description of the database; report experiences of its use in critical care for quality improvement initiatives, national registries and clinical research; and explore other potential future perspectives and developments.

Figure 1. Number of hospitals and intensive care units in countries using the Epimed Monitor Adult ICU Database with the respective starting years.

Figure 2. Yearly (2010 - 2023) trends in (A) the number of hospitals, intensive care units and intensive care unit beds and (B) the total number of intensive care unit admissions.

Figure 3. Yearly (2010 - 2023) trends in (A) the proportion of patients according to the admission type and (B) the five most frequent diagnosis categories within each admission type.

Figure 4. Yearly (2010 - 2023) trends in the frequency of mechanical ventilation, vasopressor use and renal replacement therapy.

Figure 5. Yearly (2010 - 2023) trends in (A) intensive care unit and (B) hospital lengths of stay (boxplot; the blue dots represent the mean value); (C) mean Simplified Acute Physiology Score 3 (with respective 95% confidence intervals) and hospital mortality rate.

Figura 1. Hospitais e unidades de terapia intensiva em países que usam o banco de dados Epimed Monitor de unidade de terapia intensiva adulto com os respectivos anos iniciais.

Figura 2. Tendências anuais (2010 - 2023) em (A) número de hospitais, unidades de terapia intensiva e leitos de unidades de terapia intensiva e (B) número total de internações em unidades de terapia intensiva.

Figura 3. Tendências anuais (2010 - 2023) em (A) proporção de pacientes conforme o tipo de internação e (B) as cinco categorias de diagnóstico mais frequentes em cada tipo de internação.

Figura 4. Tendências anuais (2010 - 2023) na frequência de ventilação mecânica, uso de vasopressores e terapia de substituição renal.

Figura 5. Tendências anuais (2010 - 2023) em (A) unidade de terapia intensiva e (B) tempo de internação hospitalar ( boxplot ; os pontos azuis representam o valor médio); (C) Simplified Acute Physiology Score 3 médio (com respectivos intervalos de confiança de 95%) e taxa de mortalidade hospitalar.