title: Excess mortality in winter in Finnish intensive care.
abstract: BACKGROUND
  In the general population, mortality from acute myocardial infarctions, strokes and respiratory causes is increased in winter. The winter climate in Finland is harsh. The aim of this study was to find out whether there are seasonal variations in mortality rates in Finnish intensive care units (ICUs).
  
  
  METHODS
  We analysed data on 31,040 patients treated in 18 Finnish ICUs. We measured severity of illness with acute physiology and chronic health evaluation II (APACHE II) scores and intensity of care with therapeutic intervention scoring system (TISS) scores. We assessed mortality rates in different months and seasons and used logistic regression analysis to test the independent effect of various seasons on hospital mortality. We defined 'winter' as the period from December to February, inclusive.
  
  
  RESULTS
  The crude hospital mortality rate was 17.9% in winter and 16.4% in non-winter, P = 0.003. Even after adjustment for case mix, winter season was an independent risk factor for increased hospital mortality (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.22, P = 0.005). In particular, the risk of respiratory failure was increased in winter. Crude hospital mortality was increased during the main holiday season in July. However, the severity of illness-adjusted risk of death was not higher in July than in other months. An increase in the mean daily TISS score was an independent predictor of increased hospital mortality.
  
  
  CONCLUSIONS
  Severity of illness-adjusted hospital mortality for Finnish ICU patients is higher in winter than in other seasons.
authors.affiliation: Department of Intensive Care, Savonlinna Central Hospital, Savonlinna, Finland. matti.reinikainen@fimnet.fi
authors.forename: M
authors.initials: M
authors.lastname: Reinikainen
authors.forename: A
authors.initials: A
authors.lastname: Uusaro
authors.forename: E
authors.initials: E
authors.lastname: Ruokonen
authors.forename: M
authors.initials: M
authors.lastname: Niskanen
mesh_terms: D018806:APACHE; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D005260:Female; D005387:Finland; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012621:Seasons; D016896:Treatment Outcome