Predictors of 24-h mortality after inter-hospital transfer to a tertiary medical intensive care unit

Patel, Jayshil J.; Kurman, Jonathan S.; Al-Ghandour, Easa; Thandra, Krishna Chaitanya; Mawari, Samih; Graf, Jeanette; Kovac, Jennifer; Rein, Lisa; Simpson, Steven Q.

doi:10.1177/1751143718765412

Cited by 19 publications

(29 citation statements)

References 11 publications

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“…Although there are reports of a higher mortality after ICU transfer due to a shortage of beds compared to transfers for other reasons [ 10 ], to the best of our knowledge, there is no analysis similar to ours in the literature. While there are some reports of inter-hospital transfer of patients to a tertiary centre [ 11 , 14 , 15 ], the effects of inter-hospital transfer from a tertiary centre have not been studied.…”

Section: Discussionmentioning

confidence: 99%

The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a single-centre retrospective analysis

2020

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Background Patients in the intensive care unit (ICU) are increasingly being transferred between ICUs due to a shortage of ICU beds, although this practice is potentially harmful. However, in tertiary units, the transfer of patients who are not in need of highly specialized care is often necessary. The aim of this study was to assess the association between a 90-day mortality and inter-hospital transfer due to a shortage of ICU beds in a tertiary centre. Methods Data were retrieved from the local ICU database from December 2011 to September 2019. The primary analysis was a risk-adjusted logistic regression model. Secondary analyses comprised case/control (transfer/non-transfer) matching. Results A total of 573 patients were transferred due to a shortage of ICU beds, and 8106 patients were not transferred. Crude 90-day mortality was higher in patients transferred due to a shortage of beds (189 patients (33%) vs 2188 patients (27%), p = 0.002). In the primary, risk-adjusted analysis, the risk of death at 90 days was similar between the groups (odds ratio 0.923, 95% confidence interval 0.75–1.14, p = 0.461). In the secondary analyses, a 90-day mortality was similar in transferred and non-transferred patients matched according to SAPS 3-score, age, days in the ICU and ICU diagnosis (p = 0.407); SOFA score on the day of discharge, ICU diagnosis and age (p = 0.634); or in a propensity score model (p = 0.229). Conclusion Mortality at 90 days in critically ill patients treated in a tertiary centre was not affected by transfer to another intensive care units due to a shortage of beds. We found this conclusion to be valid under the assumption that patients are carefully selected and that the transports are safely performed.

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Section: Discussionmentioning

confidence: 99%

The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a single-centre retrospective analysis

2020

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“…Moreover, roughly 2% of all discharges were referred to another ICU due to lack of resources (capacity transfers). These numbers appear to be high compared to the literature 3,20,21 , although most studies typically report transfers as a proportion of admissions to rather than discharges from ICU. The overall high numbers of transfers may partly be explained by centralisation of specialised care to the few highly populated centres in our otherwise sparsely populated country.…”

Section: Discussionmentioning

confidence: 74%

Intensive care unit to unit capacity transfers are associated with increased mortality. An observational cohort study on patient transfers in the Swedish Intensive Care Register

Parenmark

Walther

2021

Preprint

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Background Transfers from one intensive care unit (ICU) to another ICU are associated with increased length of intensive care and hospital stay. We show that non-clinical transfers due to resource constraints in the transferring ICU (capacity transfers) are associated with increased 30- and 180-day mortality compared to repatriations. Inter-hospital ICU Transfers are carried out for three main reasons: clinical transfers, capacity transfers and repatriations. We hypothesised that different ICU transfers differ in risk-adjusted mortality rate with repatriations having the least risk. Methods Observational cohort study of adult patients transferred between Swedish ICUs during 3 years (2016–2018) with follow up ending September 2019. Primary and secondary end-points were survival to 30 days and 180 days after discharge from the first ICU. Data from 75 ICUs in the Swedish Intensive Care Register, a nationwide intensive care register, was used for analysis (89 % of all Swedish ICUs). Covering local community hospitals, district general hospitals and tertiary care hospitals. We included adult patients (16 yrs. or older) admitted to ICU and subsequently discharged by transfer to another ICU. Only the first admission was used. Exposure was discharge to any other ICU (ICU to ICU transfer), whether in the same or in another hospital. Transfers were grouped into three predefined categories: clinical transfer, capacity transfer, and repatriation. Results We identified 15,588 transfers among 112,860 admissions (14.8 %) and analysed 11,176 after excluding 4,112 repeat transfer of the same individual and 300 with missing risk adjustment. The majority were clinical transfers (62.7 %), followed by repatriations (21.5 %) and capacity transfers (15.8 %). Unadjusted 30-day mortality was 25.0% among capacity transfers compared to 14.5% and 16.2% for clinical transfers and repatriations respectively. Adjusted odds ratio (OR) for 30-day mortality were 1.25 (95% CI: 1.06–1.49 P = .01) for capacity transfers and 1.17 (95% CI: 1.02–1.36 P = .03) for clinical transfers using repatriation as reference. The differences remained 180 days post discharge. Conclusions There was a large proportion of ICU to ICU transfers and an increased odds of dying for those transferred due to other reasons than repatriation.

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“…In other countries, in-hospital deaths due to SARS-CoV-2 have generally been reported to occur several days after admission [ 15 , 16 , 23 , 24 ]. This indicates that individuals tended to reach health facilities late, with less chance of survival, especially among those who required mechanical ventilation [ 25 ]. As in other countries, there was no deaths reported in children aged under 15 years in Yemen [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The first 2 months of the SARS-CoV-2 epidemic in Yemen: Analysis of the surveillance data

et al. 2020

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Introduction Yemen was one of the last countries in the world to declare the first case of the pandemic, on 10 April 2020. Fear and concerns of catastrophic outcomes of the epidemic in Yemen were immediately raised, as the country is facing a complex humanitarian crisis. The purpose of this report is to describe the epidemiological situation in Yemen during the first 2 months of the SARS-CoV-2 epidemic. Methods We analyzed the epidemiological data from 18 February to 05 June 2020, including the 2 months before the confirmation of the first case. We included in our analysis the data from 10 out of 23 governorates of Yemen, located in southern and eastern part of the country. Results A total of 469 laboratory confirmed, 552 probable and 55 suspected cases with onset of symptoms between 18 February and 5 June 2020 were reported through the surveillance system. The median age among confirmed cases was 46 years (range: 1–90 years), and 75% of the confirmed cases were male. A total of 111 deaths were reported among those with confirmed infection. The mean age among those who died was 53 years (range: 14–88 years), with 63% of deaths (n = 70) occurring in individuals under the age 60 years. A total of 268 individuals with confirmed SARS-CoV-2 infection were hospitalized (57%), among whom there were 95 in-hospital deaths, Conclusions The surveillance strategy implemented in the first 2 months of the SARS CoV 2 in the southern and eastern governorates of Yemen, captured mainly severe cases. The mild and moderate cases were not self-reported to the health facilities and surveillance system due to limited resources, stigma, and other barriers. The mortality appeared to be higher in individuals aged under 60 years, and most fatalities occurred in individuals who were in critical condition when they reached the health facilities. It is unclear whether the presence of other acute comorbidities contributed to the high death rate among SARS-CoV-2 cases. The findings only include the southern and eastern part of the country, which is home to 31% of the total population of Yemen, as the data from the northern part of the country was inaccessible for analysis. This makes our results not generalizable to the rest of the country.

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Predictors of 24-h mortality after inter-hospital transfer to a tertiary medical intensive care unit

Cited by 19 publications

References 11 publications

The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a single-centre retrospective analysis

The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a single-centre retrospective analysis

Intensive care unit to unit capacity transfers are associated with increased mortality. An observational cohort study on patient transfers in the Swedish Intensive Care Register

The first 2 months of the SARS-CoV-2 epidemic in Yemen: Analysis of the surveillance data

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