The epidemiology of chronic critical illness in the United States*.
OBJECTIVE
The epidemiology of chronic critical illness is not well characterized. We sought to determine the prevalence, outcomes, and associated costs of chronic critical illness in the United States.


METHODS
Population-based cohort study using data from the United States Healthcare Costs and Utilization Project from 2004 to 2009.


METHODS
Acute care hospitals in Massachusetts, North Carolina, Nebraska, New York, and Washington.


METHODS
Adult and pediatric patients meeting a consensus-derived definition for chronic critical illness, which included one of six eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis, or severe wounds) plus at least 8 days in an ICU.


METHODS
None.


RESULTS
Out of 3,235,741 admissions to an ICU during the study period, 246,151 (7.6%) met the consensus definition for chronic critical illness. The most common eligibility conditions were prolonged acute mechanical ventilation (72.0% of eligible admissions) and sepsis (63.7% of eligible admissions). Among patients meeting chronic critical illness criteria through sepsis, the infections were community acquired in 48.5% and hospital acquired in 51.5%. In-hospital mortality was 30.9% with little change over the study period. The overall population-based prevalence was 34.4 per 100,000. The prevalence varied substantially with age, peaking at 82.1 per 100,000 individuals 75-79 years old but then declining coincident with a rise in mortality before day 8 in otherwise eligible patients. Extrapolating to the entire United States, for 2009, we estimated a total of 380,001 cases; 107,880 in-hospital deaths and $26 billion in hospital-related costs.


CONCLUSIONS
Using a consensus-based definition, the prevalence, hospital mortality, and costs of chronic critical illness are substantial. Chronic critical illness is particularly common in the elderly although in very old patients the prevalence declines, in part because of an increase in early mortality among potentially eligible patients.
1Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine University of Pittsburgh School of Medicine, PA. 2Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. 3Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC. 4Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA. 5Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
Jeremy M
JM
Kahn
Tri
T
Le
Derek C
DC
Angus
Christopher E
CE
Cox
Catherine L
CL
Hough
Douglas B
DB
White
Sachin
S
Yende
Shannon S
SS
Carson
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D017714:Community-Acquired Infections; D003365:Costs and Cost Analysis; D016638:Critical Illness / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018805:Sepsis / Q000453:epidemiology; D017678:Sex Distribution; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult