Early indicators of prolonged intensive care unit stay: Impact of illness severity, physician staffing, and pre–intensive care unit length of stay

Higgins, Thomas L.; McGee, William T.; Steingrub, Jay S.; Rapoport, John; Lemeshow, Stanley; Teres, Daniel

doi:10.1097/00003246-200301000-00007

Cited by 201 publications

(144 citation statements)

References 42 publications

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“…We identified that higher severity of illness, shock, and BSI were independently associated with a prolonged ICU admission and that cardiovascular surgery was associated with a lower risk among all patients admitted to ICUs in our population. Several other studies 7,10,11 have investigated factors associated with prolonged admission to the ICU. Most notably, Higgins et al 7 conducted a multicentered study in 34 ICUs and found that higher severity of disease, middle age, infection, ventilation, male gender, emergency surgery, trauma, critical care fellows, and longer pre-ICU lengths of hospital stay were associated with longer ICU stays, and that the presence of full-time ICU physicians, do-not-resuscitate orders, and coma were associated with shorter admissions.…”

Section: Discussionmentioning

confidence: 99%

“…A second important aspect of our study is that it represents one of the largest studies to date investigating the epidemiology of prolonged ICU admission. Only two other studies 6,7 have included larger cohorts of patients. A final important strength of our study is that we assessed long-term outcome with follow-up for at least 1 year in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged ICU admission, as commonly defined by lengths of ICU stay Ͼ 2 to 3 weeks, have been associated with increased risk for infectious complications, adverse outcomes, and consumption of a considerable amount of ICU resources. [1][2][3][4][5][6][7][8][9] A number of studies have investigated the occurrence, risk factors, and/or outcome of prolonged admission to ICU, but a number of limitations exist. Prior studies [1][2][3][4][5][6]8,10,11 have typically been reported from highly selected patient subgroups or from single surgical or medical tertiary care ICUs such that they may not be readily generalized to critically ill populations at large.…”

mentioning

confidence: 99%

“…In addition, the majority of studies 1,2,4,5,11 to date have included relatively small numbers of patients and therefore are limited in statistical power. Furthermore, several studies 2,5,7,10,11 have had incomplete or limited duration of follow-up potentially underestimating the true impact of prolonged ICU admission.…”

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confidence: 99%

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Long-term Mortality Outcome Associated With Prolonged Admission to the ICU

Laupland

Kirkpatrick

Kortbeek

et al. 2006

Chest

120

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ICU Long-term Mortality Outcome Associated With Prolonged Admission to the This information is current as of April 19, 2006http://www.chestjournal.org/cgi/content/full/129/4/954 located on the World Wide Web at:The online version of this article, along with updated information and services, is may be reproduced or distributed without the prior written permission of the copyright holder. Long-term Mortality Outcome Associated With Prolonged Admission to the ICU* Kevin B. Laupland, MD, MSc; Andrew W. Kirkpatrick, MD, MSc; John B. Kortbeek, MD; and Danny J. Zuege, MD, MSc, FCCP Study objectives: Patients requiring prolonged admission to the ICU consume significant health-care resources and have a high rate of in-hospital death. The long-term mortality outcome of these patients has not been well defined in a nonselected cohort. The objective of this study was to describe the occurrence and factors predictive of prolonged ICU stay at admission, and to define the long-term (> 1 year) mortality outcome. Design: Population-based cohort. Setting: All adult multisystem and cardiovascular surgical ICUs in the Calgary Health Region (CHR) from July 1, 1999, to March 31, 2002. Patients: Adult (> 18 years old) residents of the CHR admitted to regional ICUs. Interventions: None. Measurements and results: During the study, 4,845 patients had a median length of stay of 2 days (interquartile range, 1 to 4 days); 2,115 patients (44%) were admitted for < 2 days, 1,496 patients (31%) were admitted for 2 to 3 days; 1,018 patients (21%) were admitted from 4 to 13 days; and 216 patients (4%) had a prolonged (> 14 day) admission to the ICU. A higher severity of illness, the presence of shock, and bloodstream infection were independently associated with a prolonged ICU admission, and cardiovascular surgery was associated with a lower risk. Patients with prolonged ICU admissions were nearly twice as likely to die as patients with shorter ICU admissions: 53 of 216 patients (25%) vs 584 of 4,629 patients (13%) [p ‫؍‬ 0.0001]. Among the 3,924 survivors to hospital discharge, the rates of mortality during the year following ICU admission were as follows: 59 deaths in 1,758 patients (3%) admitted < 2 days, 74 deaths in 1,267 patients (6%) with 2-to 3-day admissions, 78 deaths in 766 patients (10%) with 4-to 13-day admissions, and 10 deaths in 133 patients (8%) with admissions > 14 days. Conclusions: One in 25 critically ill patients will have prolonged ICU admission and higher ICU-related mortality. However, survivors of prolonged ICU admission have good long-term mortality outcome after acute illness.( Kevin B. Laupland, MD, MSc,#9, 3535 Research Rd NW, University of Calgary, Calgary, AB, Canada T2L 2K8; of studies have investigated the occurrence, risk factors, and/or outcome of prolonged admission to ICU, but a number of limitations exist. Prior studies [1][2][3][4][5][6]8,10,11 have typically been reported from highly selected patient subgroups or from single surgical or medical tertiary care ICUs such that they may not be readily ge...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Long-term Mortality Outcome Associated With Prolonged Admission to the ICU

Laupland

Kirkpatrick

Kortbeek

et al. 2006

Chest

120

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“…These studies are limited because of concerns about secular trends in outcomes, ability to control for confounding variables, and generalizability of single-center studies. Relatively few studies using large cohorts of patients with well-defined critical illness syndromes have explored this question (18)(19)(20)(21)(22).…”

mentioning

confidence: 99%

Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury

Treggiari¹,

Martin²,

Yanez³

et al. 2007

Am J Respir Crit Care Med

123

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Rationale: Prior studies supported an association between intensive care unit (ICU) organizational model or staffing patterns and outcome in critically ill patients. Objectives: To examine the association of closed versus open models with patient mortality across adult ICUs in King County (WA). Methods: Cohort study of patients with acute lung injury (ALI). Measurements and Main Results: ICU structure, organization, and patient care practices were assessed using self-administered mail questionnaires completed by the medical director and nurse manager. We defined closed ICUs as units that required patient transfer to or mandatory patient comanagement by an intensivist and open ICUs as those relying on other organizational models. Outcomes were obtained from the King County Lung Injury Project, a populationbased cohort of patients with ALI. The main endpoint was hospital mortality. Of 24 eligible ICUs, 13 ICUs were designated closed and 11 open. Complete survey data were available for 23 (96%) ICUs. Higher physician and nurse availability was reported in closed versus open ICUs. A total of 684 of 1,075 (63%) of patients with ALI were cared for in closed ICUs. After adjusting for potential confounders, patients with ALI cared for in closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P 5 0.004). Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P 5 0.62). These findings were robust for varying assumptions about the study population definition. Conclusions: Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.

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