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Outcomes of patients admitted to tertiary intensive care units after interhospital transfer: comparison with patients admitted from emergency departments.
Crit Care Resusc 2008; 10(2):97-105CC

Abstract

OBJECTIVES

To compare outcomes of patients admitted to tertiary-level intensive care units after interhospital transfer (IHT) with those of similar patients admitted from the emergency department (ED).

DESIGN

Historical case-control study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD), a quality-assurance dataset.

PARTICIPANTS AND SETTING

28882 patients aged 16 years or older admitted to an adult tertiary ICU in Australia or New Zealand between 1 January 1994 and 31 December 2003 with one of the eight most common diagnoses for IHT patients. Patients admitted directly to the ICU from another hospital (DIHT group) (n=9203) were matched by age, sex, APACHE II score and diagnosis with non-IHT patients admitted from the ED (ED group).

RESULTS

Hospital mortality was higher in the DIHT group than in the ED group for patients with a diagnosis of multiple trauma (11.0% v 5.1%; odds ratio [OR], 2.3; 95% CI, 1.6- 3.34), respiratory infection (28.1% v 19.1%; OR, 1.66; 95% CI, 1.34-2.05), sepsis (38.7% v 28.7%; OR, 1.57; 95% CI, 1.34-1.83), intracranial haemorrhage (49.9% v 42.6%; OR, 1.34; 95% CI, 1.14-1.58), head injury alone (16.9% v 13.7%; OR, 1.28; 95% CI, 1.01-1.62), and cardiac arrest (59.3% v 53.2%; OR, 1.28; 95% CI, 1.06-1.56), but not overdose (3.9% v 3.6%; OR, 1.09; 95% CI, 0.72-1.67) or chronic obstructive pulmonary disease (19.8% v 22.5%; OR, 0.85; 95% CI, 0.63-1.15). Overall, the DIHT group had a higher intubation rate, longer ICU stay and higher rate of discharge to another hospital.

CONCLUSIONS

Patients admitted to an ICU from another hospital have higher hospital mortality and longer stay than those admitted from the ED, with the differences varying between diagnoses. These differences are important considerations for resource allocation and triage, and as a measure of quality.

Authors+Show Affiliations

Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA. Arthas.Flabouris@health.sa.gov.auNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18522522

Citation

Flabouris, Arthas, et al. "Outcomes of Patients Admitted to Tertiary Intensive Care Units After Interhospital Transfer: Comparison With Patients Admitted From Emergency Departments." Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, vol. 10, no. 2, 2008, pp. 97-105.
Flabouris A, Hart GK, George C. Outcomes of patients admitted to tertiary intensive care units after interhospital transfer: comparison with patients admitted from emergency departments. Crit Care Resusc. 2008;10(2):97-105.
Flabouris, A., Hart, G. K., & George, C. (2008). Outcomes of patients admitted to tertiary intensive care units after interhospital transfer: comparison with patients admitted from emergency departments. Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, 10(2), pp. 97-105.
Flabouris A, Hart GK, George C. Outcomes of Patients Admitted to Tertiary Intensive Care Units After Interhospital Transfer: Comparison With Patients Admitted From Emergency Departments. Crit Care Resusc. 2008;10(2):97-105. PubMed PMID: 18522522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of patients admitted to tertiary intensive care units after interhospital transfer: comparison with patients admitted from emergency departments. AU - Flabouris,Arthas, AU - Hart,Graeme K, AU - George,Carol, PY - 2008/6/5/pubmed PY - 2008/11/1/medline PY - 2008/6/5/entrez SP - 97 EP - 105 JF - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JO - Crit Care Resusc VL - 10 IS - 2 N2 - OBJECTIVES: To compare outcomes of patients admitted to tertiary-level intensive care units after interhospital transfer (IHT) with those of similar patients admitted from the emergency department (ED). DESIGN: Historical case-control study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD), a quality-assurance dataset. PARTICIPANTS AND SETTING: 28882 patients aged 16 years or older admitted to an adult tertiary ICU in Australia or New Zealand between 1 January 1994 and 31 December 2003 with one of the eight most common diagnoses for IHT patients. Patients admitted directly to the ICU from another hospital (DIHT group) (n=9203) were matched by age, sex, APACHE II score and diagnosis with non-IHT patients admitted from the ED (ED group). RESULTS: Hospital mortality was higher in the DIHT group than in the ED group for patients with a diagnosis of multiple trauma (11.0% v 5.1%; odds ratio [OR], 2.3; 95% CI, 1.6- 3.34), respiratory infection (28.1% v 19.1%; OR, 1.66; 95% CI, 1.34-2.05), sepsis (38.7% v 28.7%; OR, 1.57; 95% CI, 1.34-1.83), intracranial haemorrhage (49.9% v 42.6%; OR, 1.34; 95% CI, 1.14-1.58), head injury alone (16.9% v 13.7%; OR, 1.28; 95% CI, 1.01-1.62), and cardiac arrest (59.3% v 53.2%; OR, 1.28; 95% CI, 1.06-1.56), but not overdose (3.9% v 3.6%; OR, 1.09; 95% CI, 0.72-1.67) or chronic obstructive pulmonary disease (19.8% v 22.5%; OR, 0.85; 95% CI, 0.63-1.15). Overall, the DIHT group had a higher intubation rate, longer ICU stay and higher rate of discharge to another hospital. CONCLUSIONS: Patients admitted to an ICU from another hospital have higher hospital mortality and longer stay than those admitted from the ED, with the differences varying between diagnoses. These differences are important considerations for resource allocation and triage, and as a measure of quality. SN - 1441-2772 UR - https://www.unboundmedicine.com/medline/citation/18522522/Outcomes_of_patients_admitted_to_tertiary_intensive_care_units_after_interhospital_transfer:_comparison_with_patients_admitted_from_emergency_departments_ DB - PRIME DP - Unbound Medicine ER -