title: Survival of critically ill patients hospitalized in and out of intensive care.
abstract: OBJECTIVE
  A lack of intensive care units beds in Israel results in critically ill patients being treated outside of the intensive care unit. The survival of such patients is largely unknown. The present study's objective was to screen entire hospitals for newly deteriorated patients and compare their survival in and out of the intensive care unit.
  
  
  METHODS
  A priori developed intensive care unit admission criteria were used to screen, during 2 wks, the patient population for eligible incident patients. A screening team visited every hospital ward of five acute care hospitals daily. Eligible patients were identified among new admissions in the emergency department and among hospitalized patients who acutely deteriorated. Patients were followed for 30 days for mortality regardless of discharge.
  
  
  METHODS
  Five acute care hospitals.
  
  
  METHODS
  A total of 749 newly deteriorated patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  Crude survival of patients in and out of the intensive care unit was compared by Kaplan-Meier curves, and Cox models were constructed to adjust the survival comparisons for residual case-mix differences. A total of 749 newly deteriorated patients were identified among 44,000 patients screened (1.7%). Of these, 13% were admitted to intensive care unit, 32% to special care units, and 55% to regular departments. Intensive care unit patients had better early survival (0-3 days) relative to regular departments (p=.0001) in a Cox multivariate model. Early advantage of intensive care was most pronounced among patients who acutely deteriorated while on hospital wards rather than among newly admitted patients.
  
  
  CONCLUSIONS
  Only a small proportion of eligible patients reach the intensive care unit, and early admission is imperative for their survival advantage. As intensive care unit benefit was most pronounced among those deteriorating on hospital wards, intensive care unit triage decisions should be targeted at maximizing intensive care unit benefit by early admitting patients deteriorating on hospital wards.
authors.affiliation: Department of Health Services Research, Ministry of Health, Jerusalem, Israel. esimchen@vms.huji.ac.il
authors.forename: Elisheva
authors.initials: E
authors.lastname: Simchen
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Noya
authors.initials: N
authors.lastname: Galai
authors.forename: Yana
authors.initials: Y
authors.lastname: Zitser-Gurevich
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-Lavi
authors.forename: Leon
authors.initials: L
authors.lastname: Levi
authors.forename: Fabio
authors.initials: F
authors.lastname: Zveibil
authors.forename: Micha
authors.initials: M
authors.lastname: Mandel
authors.forename: George
authors.initials: G
authors.lastname: Mnatzaganian
authors.forename: Nethanel
authors.initials: N
authors.lastname: Goldschmidt
authors.forename: Anat
authors.initials: A
authors.lastname: Ekka-Zohar
authors.forename: Inbal
authors.initials: I
authors.lastname: Weiss-Salz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015996:Survival Rate