The longer patients are in hospital before Intensive Care admission the higher their mortality.
OBJECTIVE
To explore the relationship between hospital mortality and time spent by patients on hospital wards before admission to the intensive care unit (ICU).


METHODS
Observational study of prospectively collected data.


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


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


METHODS
None.


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.
Goldhill
David R
DR
Department of Anaesthesia and Critical Care Medicine, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. david.goldhill@rnoh.nhs.uk
McNarry
Alistair F
AF
Hadjianastassiou
Vassilis G
VG
Tekkis
Paris P
PP
D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors