Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study.
OBJECTIVE
To evaluate whether a relation exists between volume and outcome for admissions with severe sepsis to adult general critical care units in the United Kingdom.


METHODS
Retrospective cohort study using data from a pooled case mix and outcome database.


METHODS
Adult general critical care units participating in the case mix programme.


METHODS
Consecutive admissions to participating units for the years 2008-09 meeting objective, standardised criteria for severe sepsis.


METHODS
Mortality at ultimate discharge from acute hospital.


RESULTS
The primary exposure was volume of admissions with severe sepsis per unit per year. A multivariable logistic regression analysis, using generalised estimating equations, was used to assess the association between volume, modelled using fractional polynomials, and ultimate acute hospital mortality while adjusting for potential confounders. No relation was seen between volume and outcome for admissions with severe sepsis to adult, general critical care units in the UK. Subgroup analyses tested for interactions between the effect of volume and acute severity of illness or receipt of mechanical ventilation. No significant interactions were found.


CONCLUSIONS
This study showed no relation between volume and outcome in admissions with severe sepsis treated in adult general critical care units in the UK.
Department of Critical Care, Respiratory Division, McGill University, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4. Jason.shahin@mcgill.ca
Jason
J
Shahin
David A
DA
Harrison
Kathryn M
KM
Rowan
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003953:Diagnosis-Related Groups; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D018579:Patient Selection; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology