Document Detail


Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center.
MedLine Citation:
PMID:  12847392     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe characteristics of patients transferred from outside hospitals to a tertiary medical intensive care unit and to identify patient-level and system-level prognostic factors. DESIGN: Retrospective cohort study. SETTING: Tertiary university hospital. PATIENTS: We studied 3,347 patients who were transferred to the medical intensive care unit from outside hospitals from January 1990 through September 1999. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data collected included patient demographics, insurance type, discharge diagnoses, length of stay, mortality, admitting service, and distance traveled. The Charlson Comorbidity Score was used to adjust for comorbidity and the diagnostic related group risk level for risk of adverse outcome. Multivariate logistic models of early mortality (<72 hrs) and overall hospital mortality rate were developed. The most common major diagnostic categories included neurologic (10%), respiratory (10%), digestive diseases (10%), and drug overdose (10%). Most patients (70%) were transferred from >60 miles away. Mean medical intensive care unit length of stay was 5.3 days vs. 3.9 days for nontransfer patients. Transfer patients accounted for 49% of medical intensive care unit admits and 56% of intensive care unit patient-days. The overall mortality rate for transfer patients to the medical intensive care unit was 25% (95% confidence interval, 23-26), significantly higher than the 21% (95% confidence interval, 19-22) mortality rate among those admitted directly. Independent prognostic factors for early death (<72 hrs) included male gender, summer season, admitting service, diagnostic related group level, Charlson Comorbidity Score, insurance type, and major diagnostic category. Independent prognostic factors for overall hospital mortality rate included length of stay, medical complication, distance traveled, insurance type, and major diagnostic category. CONCLUSIONS: Interhospital transfers to the medical intensive care unit are patients at high risk for mortality and other adverse outcomes. System-level and patient-level characteristics influence both early and overall hospital mortality rates. These variables should be considered when risk stratifying medical intensive care unit patients and in studying outcomes of care.
Authors:
Lakshmi Durairaj; Joseph G Will; James C Torner; Bradley N Doebbeling
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-08     Completed Date:  2003-08-12     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1981-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Comorbidity
Critical Illness / mortality*
Data Interpretation, Statistical
Diagnosis-Related Groups / statistics & numerical data
Female
Hospital Mortality*
Hospitals, University
Humans
Intensive Care Units / statistics & numerical data*
Iowa
Length of Stay / statistics & numerical data
Male
Middle Aged
Patient Admission / statistics & numerical data
Patient Transfer / statistics & numerical data*
Prognosis
Retrospective Studies
Risk Factors
Grant Support
ID/Acronym/Agency:
5 T32 HL07638-14/HL/NHLBI NIH HHS; N01-NLM-96-105MVA/LM/NLM NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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