Is intensive care worth it?–An assessment of input and outcome for the critically ill

Sage, William M.; Rosenthal, Myer H.; Silverman, James E.

doi:10.1097/00003246-198609000-00004

Cited by 105 publications

(51 citation statements)

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“…Our response rate of 56% falls within the range reported in other studies in which patients were questioned by post i.e. 41% [4], 70% [8], 76% (excluding overdose patients) [lo]. Ridley and Wallace had a response rate of 84% from the letters which reached the patients but this was only 61% of the letters sent [ll].…”

Section: Discussionsupporting

confidence: 79%

Health and activity after intensive care

1995

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SummaryAll patients discharged from a general intensive care unit over a 4.5year period were sent a questionnaire 3 months after discharge which investigated aspects of their health andphysical abilities. Replies were compared on the basis of age, diagnosis and sickness severity on admission. Five hundred and four questionnaires were analysed. Overall, 47% of patients described their health as goodlvery good, 42% as fair and I I % as poor/very poor. Activity level, compared to that before their admission, was unchanged in 59%, worse in 33% and improved in 8% ofpatients. There were no differences in health status or changes in activity with age, diagnosis or severity of sickness. Patients aged 76 years or older were more likely to perceive their health as 'better than average' than younger patients @ < 0.01). Eight percent of patients would be unwilling to undergo intensive care again. An unacceptable health status after intensive care cannot be predicted in any group of patients.

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Section: Discussionsupporting

confidence: 79%

Health and activity after intensive care

1995

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“…Reports of quality of life (QOL) after intensive therapy are inconsistent; some studies suggest an improvement in QOL [2] while others suggest deterioration [3-51.…”

Section: Introductionmentioning

confidence: 99%

“…Costs vary according to treatment regimens and different facilities offered by different intensive therapy units (ITUs). Outcome may be measured as the quality and duration of survival after the patient has returned home.Reports of quality of life (QOL) after intensive therapy are inconsistent; some studies suggest an improvement in QOL [2] while others suggest deterioration [3-51.Intensive care provides life-saving rather than specific therapy aimed at an underlying disease. Therefore, the best duration of survival 'of patients without chronic or malignant disease is normal life expectancy.…”

mentioning

confidence: 99%

“…Reports of quality of life (QOL) after intensive therapy are inconsistent; some studies suggest an improvement in QOL [2] while others suggest deterioration [3-51. Intensive care provides life-saving rather than specific therapy aimed at an underlying disease. Therefore, the best duration of survival 'of patients without chronic or malignant disease is normal life expectancy.…”

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confidence: 99%

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Survival after intensive care

Ridley

Plenderleith

1994

Anaesthesia

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The l f e expectancy for survivors of critical illness has not been reported in the United Kingdom. The aim of this study was to compare the long-term survival of intensive care patients with that of an age and sex-matched population. AN patients admitted to a general intensive therapy unit over 4 years (n = 1168) were included in the study. Details of the survivors were forwarded to the Registrar General for Scotland, who then issued copies of death certijicates as the survivors died. The survival curve of patients discharged from the intensive therapy unit was significantly diyerent from that of the normal population. The risk of dying in the first year after discharge was 3.4 times higher (95% confidence intervals 2.7-4.2) than that in the normal population. It is not until the start of the fourth year after discharge that the probability of death matched that of the normal population. Key wordsIntensive therapy; survival.Effectiveness may be expressed as a balance between cost and outcome but assessing the effectiveness of intensive therapy is difficult because of wide variations in cost and outcome [ 11. Costs vary according to treatment regimens and different facilities offered by different intensive therapy units (ITUs). Outcome may be measured as the quality and duration of survival after the patient has returned home.Reports of quality of life (QOL) after intensive therapy are inconsistent; some studies suggest an improvement in QOL [2] while others suggest deterioration [3-51.Intensive care provides life-saving rather than specific therapy aimed at an underlying disease. Therefore, the best duration of survival 'of patients without chronic or malignant disease is normal life expectancy. Attempts to relate the numbers of survivors with normal life expectancy to the cost of critical illness may estimate effectiveness and yet partly overcome the variability of intensive therapy. Therefore the aims of this study were to compare the long-term survival of intensive care patients with an age and sexmatched population and attempt to apply long-term survival as a measure of effectiveness. MethodsAll patients (1168 in total) admitted to the ITU of the Western Infirmary, Glasgow, between June 1985 and June 1989 were studied. The patients' age, diagnosis and APACHE I1 score [6] were recorded on admission. On discharge, details of the ITU survivors were forwarded to the Office of the Registrar General for Scotland. The Registrar General issued a copy of the death certificate when any patient within the study group died before 1 January 1993. Therefore patients were followed for between 3.5 and 7.5 years, depending upon the date of admission.Calculation of a theoretical survival curve for an age and sex-matched normal population is possible using statistics released by the Scottish Office [7J Similarly, expectation of life of patients with a known age and sex distribution can be calculated from abridged life tables [8].During the study period, the treatments of 90 patients were costed accurately on an individual and...

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“…It has been reported that y40% of the patients admitted to ICUs never received active intensive care, including mechanical ventilation [8][9][10]. Onlyy40% of patients with ARF due to pulmonary disease needed to be invasively ventilated [11,12].…”

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confidence: 99%