title: Outcome of mechanically ventilated patients initially denied admission to an intensive care unit and subsequently admitted.
abstract: The outcome of mechanically ventilated patients initially denied admission to an intensive care unit (ICU) and subsequently admitted is unclear. We compared outcomes of patients denied ICU admission and subsequently admitted, to those of patients admitted to the ICU and to patients refused ICU admission. The medical records of all the patients who were subjected to mechanical ventilation for at least 24h over a 4year period (2010-2014) were reviewed. Of 707 patients (757 admissions), 124 (18%) were initially denied ICU admission and subsequently admitted. Multivariate stepwise logistic regression analysis showed significant association with death of: age, length of stay, nursing home residency, duration of mechanical ventilation, previous admission with mechanical ventilation, cause for mechanical ventilation, rate of failed extubations, associated morbidity (previous cerebrovascular accident, dementia, chronic renal failure), and occurrence of nosocomial bacteremia. The odds for death among patients denied ICU admission and subsequently transferred to the ICU compared to patients admitted directly to the ICU was 3.6 (95% CI: 1.9-6.7) (P<0.0001). The odds for death among patients refused ICU admission compared to those who were initially denied and subsequently admitted were not statistically significant (OR=1.7, 95% CI: 0.8-3.8). In conclusion, patients denied ICU admission and subsequently admitted face a considerable risk of morbidity and mortality. Their odds of death are nearly three times those admitted directly to the ICU. Late admission to the ICU does not appear to provide benefit compared to patients who remain in general medicine wards.
authors.affiliation: Department of Medicine D, Emek Medical Center, Afula, Israel.
authors.forename: Wasim
authors.initials: W
authors.lastname: Naser
authors.affiliation: Clinical Research Unit, Emek Medical Center, Afula, Israel.
authors.forename: Naama
authors.initials: N
authors.lastname: Schwartz
authors.affiliation: Intensive Care Unit, Emek Medical Center, Afula, Israel.
authors.forename: Richard
authors.initials: R
authors.lastname: Finkelstein
authors.affiliation: Department of Medicine D, Emek Medical Center, Afula, Israel; The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: bisharat_na@clalit.org.il.
authors.forename: Naiel
authors.initials: N
authors.lastname: Bisharat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: General medicine; Hospital admission; Intensive care unit; Mechanical ventilation; Mortality