Intensive Care Utilization during Hospital Admission for Delivery

Panchal, Sumedha; Arria, Amelia M.; Harris, Andrew P.

doi:10.1097/00000542-200006000-00009

Cited by 98 publications

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“…The mortality rate was also similar to that in other, smaller studies in the UK [18-20]. However, small studies from other countries reported widely varying mortality rates, reflecting different spectra of disease and admission criteria and making comparisons across health care systems difficult [3,4,6,21-29]. …”

Section: Discussionsupporting

confidence: 82%

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et al. 2005

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IntroductionRisk prediction scores usually overestimate mortality in obstetric populations because mortality rates in this group are considerably lower than in others. Studies examining this effect were generally small and did not distinguish between obstetric and nonobstetric pathologies. We evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II model in obstetric admissions to critical care units contributing to the ICNARC Case Mix Programme.MethodsAll obstetric admissions were extracted from the ICNARC Case Mix Programme Database of 219,468 admissions to UK critical care units from 1995 to 2003 inclusive. Cases were divided into direct obstetric pathologies and indirect or coincidental pathologies, and compared with a control cohort of all women aged 16–50 years not included in the obstetric categories. The predictive ability of APACHE II was evaluated in the three groups. A prognostic model was developed for direct obstetric admissions to predict the risk for hospital mortality. A log-linear model was developed to predict the length of stay in the critical care unit.ResultsA total of 1452 direct obstetric admissions were identified, the most common pathologies being haemorrhage and hypertensive disorders of pregnancy. There were 278 admissions identified as indirect or coincidental and 22,938 in the nonpregnant control cohort. Hospital mortality rates were 2.2%, 6.0% and 19.6% for the direct obstetric group, the indirect or coincidental group, and the control cohort, respectively. Cox regression calibration analysis showed a reasonable fit of the APACHE II model for the nonpregnant control cohort (slope = 1.1, intercept = -0.1). However, the APACHE II model vastly overestimated mortality for obstetric admissions (mortality ratio = 0.25). Risk prediction modelling demonstrated that the Glasgow Coma Scale score was the best discriminator between survival and death in obstetric admissions.ConclusionThis study confirms that APACHE II overestimates mortality in obstetric admissions to critical care units. This may be because of the physiological changes in pregnancy or the unique scoring profile of obstetric pathologies such as HELLP syndrome. It may be possible to recalibrate the APACHE II score for obstetric admissions or to devise an alternative score specifically for obstetric admissions.

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Section: Discussionsupporting

confidence: 82%

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et al. 2005

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“…2,13-21 Medical, obstetric, and demographic conditions shown to be predictive of severe maternal morbidity were included in the analysis. 16,20 Based on data from the United Kingdom comorbid risk factors such as diabetes, hypertensive diseases of pregnancy, and substance abuse have also been shown to be associated with increased risk for mortality.…”

Section: Methodsmentioning

confidence: 99%

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Friedman

Ananth

Huang

et al. 2016

American Journal of Obstetrics and Gynecology

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Background In the setting of persistently high risk for maternal mortality and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. Objective The objectives of this analysis were (i) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States; and (ii) to characterize, by hospital volume, the risk for mortality in the setting of severe obstetrical morbidity – a concept known as failure to rescue. Study Design This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998 to 2010. The main outcome measures were (i) severe morbidity defined as a composite of any one of fifteen diagnoses representative of acute organ injury and critical illness, and (ii) failure to rescue, defined as death in the setting of severe morbidity. Results The prevalence of severe morbidity rose from 471.2 to 751.5 cases per 100,000 deliveries from 1998 to 2010, an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared to other factors was relatively small. Conclusions While low and high delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in determining outcomes.

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“…Only few population-level studies were reported to date on the epidemiology of obstetric ICU utilization in high-resource countries [7, 10, 15, 16]. However, there is marked variability in international availability of critical care resources and practice patterns [17].…”

Section: Introductionmentioning

confidence: 99%

“…Data to date could not quantify the overall demand for ICU services in non-delivery patient strata (i.e., women having fetal loss or induced abortion) in the obstetric population at large, nor for the whole obstetric population. In addition, investigators generally did not address ICU utilization in non-delivery hospitalizations (i.e., anterpartum, postpartum) [15, 16]. Non-delivery hospitalizations involve for the most part women with complications brought by or aggravated by pregnancy, who thus would be expected to have higher rates of ICU utilization, as compared to delivery hospitalizations, where the majority of women have relatively uneventful clinical course.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001 - 2010

Oud

2017

J Clin Med Res

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BackgroundICU admission is uncommon among obstetric patients. Nevertheless, the epidemiology of ICU utilization is considered to be a useful proxy for study of severe maternal morbidity and near-miss events. However, there is paucity of population-level studies in obstetric patients in the United States.MethodsThe Texas Inpatient Public Use Data File and state-based reports were used to identify pregnancy-associated hospitalizations and those involving admission to ICU (n = 158,410) for the years 2001 - 2010. The clinical characteristics, outcomes, and the overall incidence and temporal trends of ICU admission were examined and stratified analyses of pregnancy outcomes were performed in specific categories of pregnancy-associated hospitalizations. In addition, ICU utilization among hospitalizations with maternal complications and organ dysfunction was evaluated.ResultsChronic comorbidities (9.7%) and presence of organ dysfunction (6.2%) were uncommon among ICU admissions, with 26.5% having high severity of illness. The incidence of ICU admission was 39.0 per 1,000 pregnancy-associated hospitalizations-years. Marked variability was found in ICU admission both across pregnancy outcomes (ranging from 0.6 per 1,000 abortions-years to 85.9 per 1,000 stillbirths-years) and categories of pregnancy-associated hospitalizations (ranging from 32.1 per 1,000 delivery hospitalizations-years to 144.8 per 1,000 postpartum hospitalizations-years). The incidence of ICU admission rose 68% among pregnancy-associated hospitalizations and for all examined subgroups, except abortion. Preeclampsia/eclampsia (23.3%) and obstetric hemorrhage (6.9%) were the most common maternal complications among ICU admissions. Four hundred fourteen women (0.3%) died, while 97.6% were discharged home.ConclusionsThis study documents the highest incidence of ICU utilization in obstetric patients in the US to date. The findings suggest low threshold for obstetric ICU admissions in the state and do not support comparative use of ICU utilization as surrogate measure for populations’ burden of severe maternal morbidity and near-miss events. Nevertheless, the demonstrated tremendous heterogeneity in ICU utilization across examined subgroups identifies new high-risk groups of obstetric patients that would benefit from heightened clinician vigilance and timely ICU triage and care. Further studies are needed to inform reduction in avoidable variability in ICU utilization to both enhance maternal, fetal, and neonatal outcomes and to improve resource allocation.

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Intensive Care Utilization during Hospital Admission for Delivery

Abstract: This study shows that ICU use and mortality rate during hospital admission for delivery of a neonate is low. These results may influence the location of perinatal ICU services in the hospital setting.

Cited by 98 publications

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Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001 - 2010

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