Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)
Air in the scrotum is an unusual clinical finding and a thorough search should be done in order to locate the air leak or source of gas production. We report an 81-year-old patient who developed severe acute respiratory failure after fiberoptic bronchoscopy and was intubated immediately. After tracheal intubation, excessive subcutaneous emphysema from the head to the scrotum was obvious. Chest tube thoracostomies were placed to treat pneumothorax. The emphysema was absorbed after 13 days without any sequela. Air or gas inside the scrotum may originate from intraperitoneal, extraperitoneal, or local sources. The majority of the cases can be managed conservatively, but emergent intervention is needed in life-threatening situations.
Background: During the last decades the combination of international economic and healthcare crisis has led to pressure on healthcare systems and has made financial evaluations particularly important.Aim: To measure the total cost in ICUs, to analyze its components, and their changes during the study period.Method and Material: All cost components in four cost categories (direct-variable, direct-fixed, indirect-variable, and indirect-fixed) of all patients admitted in a 6-bed mixed type adult ICU in a general (non-university) hospital of northern Greece in two consecutive periods, with total duration 2 years was measured. The direct-variable cost (medications, consumables, and diagnostic tests) was assessed with bottom-up (micro-costing) method while for the cost components of rest three categories the top-down (attributable costing) was used. Results: In a 331 patients’ sample with 2823 total patient days, the sum cost was 2,417,788€ (1,370,420€ and 1,047,368€ in 1st and 2nd period respectively). The direct variable cost was 897,866.07€ (37.14%), the direct-fixed 1,049,068.6€ (43.39%), the indirect-variable 45,210.6€ (1.87%), and the indirect-fixed 425,643.0€ (17.60%). The mean daily cost per patient was 835.62€ and 885.35€, and the total cost per patient was 7,967.6€ and 6,587.2€ in the two periods of study respectively. The total cost of all non-survivors’ patients (N=85, 25.7%) was 595,009.1€ and the efficiency cost per survivor 9,828.4€. The mean daily cost and the total cost per survivor was 840.8€ and 7,409.7€ while for non-survivors was και 908.4€ and 7,000.1€ respectively. During the second study period, a reduction in total costs was observed and especially in direct-variable category attributed mainly to the prices of medicines consumables, and staff gradual costs reductions.Conclusions: Changes in cost categories vary over time due to social and financial factors while the variables as the ICU environment or patient’s characteristics as severity of disease are the main cost drivers. Monitoring and recording of cost components variance would help with valuable information to healthcare managers, doctors, or nursing leaders. Extending this study with a multicenter to more ICUs could provide clearer conclusions about cost variability.
Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.
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