title: Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study.
abstract: BACKGROUND
  The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU.
  
  
  METHODS
  An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days).
  
  
  RESULTS
  One hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P <0.001). After adjustment for patient characteristics at admission such as illness severity, and ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002).
  
  
  CONCLUSIONS
  The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01422070. Registered 19 August 2011.
authors: Maurizia
authors: M
authors: Capuzzo
authors: Carlo
authors: C
authors: Volta
authors: Tania
authors: T
authors: Tassinati
authors: Rui
authors: R
authors: Moreno
authors: Andreas
authors: A
authors: Valentin
authors: Bertrand
authors: B
authors: Guidet
authors: Gaetano
authors: G
authors: Iapichino
authors: Claude
authors: C
authors: Martin
authors: Thomas
authors: T
authors: Perneger
authors: Christophe
authors: C
authors: Combescure
authors: Antoine
authors: A
authors: Poncet
authors: Andrew
authors: A
authors: Rhodes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000639:trends; D007362:Intensive Care Units / Q000639:trends; D007380:Intermediate Care Facilities / Q000639:trends; D010343:Patient Admission / Q000639:trends