title: Substance abuse-related admissions to adult intensive care.
abstract: The frequency of adult surgical and medical intensive care unit (ICU) admissions related to substance abuse was determined at a large community, trauma, and tertiary referral hospital. Of 435 ICU admissions, 14 percent (95 percent confidence interval [CI], 5 to 23 percent) were tobacco related generating 16 percent of costs, 9 percent (95 percent CI, 0 to 18 percent) were alcohol related generating 13 percent of costs, and 5 percent (95 percent CI, 0 to 14 percent) were illicit drug related generating 10 percent of costs. In all, 28 percent (95 percent CI, 20 to 36 percent) of ICU admissions generating 39 percent of costs were substance abuse related. Substance abuse-related admissions were significantly longer and more costly than admissions not related to substance abuse (4.2 days vs 2.8 days, p = 0.004; $9,610 vs $5,890, p = 0.001). Frequency of substance abuse-related admission was linked with the patient's insurance status (Medicare, private insurance, uninsured). In the uninsured group, 44 percent of admissions were substance abuse related (95 percent CI, 35 to 52 percent), significantly higher than in the private insurance and Medicare groups, and generating 61 percent of all ICU costs in the uninsured group. Large fractions of adult ICU admissions and costs are substance abuse related, particularly in uninsured patients.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: W A
authors.initials: WA
authors.lastname: Baldwin
authors.forename: B A
authors.initials: BA
authors.lastname: Rosenfeld
authors.forename: M J
authors.initials: MJ
authors.lastname: Breslow
authors.forename: T G
authors.initials: TG
authors.lastname: Buchman
authors.forename: C S
authors.initials: CS
authors.lastname: Deutschman
authors.forename: R D
authors.initials: RD
authors.lastname: Moore
mesh_terms: D000328:Adult; D001741:Black or African American; D000437:Alcoholism / Q000191:economics / Q000453:epidemiology; D015142:Baltimore / Q000453:epidemiology; D003365:Costs and Cost Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D013287:Illicit Drugs; D007348:Insurance, Health; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000191:economics / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology*; D014481:United States; D044465:White People
chemical_list: D013287:Illicit Drugs