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Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.
Crit Care Med. 2009 Nov; 37(11):2867-74.CC

Abstract

OBJECTIVE

To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients).

DESIGN

Secondary analysis of the original data from two North American and two European prospective, multicenter, cohort studies of adult patients with community-acquired pneumonia.

PATIENTS

In all, 453 non-institutionalized patients transferred within 3 days of emergency department presentation to an intensive care unit were included in the analysis. Supplementary analysis was restricted to patients without an obvious indication for immediate transfer to an intensive care unit.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The sample consisted of 138 delayed-transfer and 315 direct-transfer patients, among whom 150 (33.1%) were considered to have an obvious indication for immediate intensive care unit admission. After adjusting for the quintile of propensity score, delayed intensive care unit transfer was associated with an increased odds ratio for 28-day mortality (2.07; 95% confidence interval, 1.12-3.85) and a decreased odds ratio for discharge from hospital for survivors (0.53; 95% confidence interval, 0.39-0.71). In a propensity-matched analysis, delayed-transfer patients had a higher 28-day mortality rate (23.4% vs. 11.7%; p = 0.02) and a longer median hospital length of stay (13 days vs. 7 days; p < .001) than direct-transfer patients. Similar results were found after excluding the 150 patients with an obvious indication for immediate intensive care unit admission.

CONCLUSIONS

Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines.

Authors+Show Affiliations

Department of Emergency Medicine, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France. bertrand.renaud@hmn.aphp.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19770748

Citation

Renaud, Bertrand, et al. "Association Between Timing of Intensive Care Unit Admission and Outcomes for Emergency Department Patients With Community-acquired Pneumonia." Critical Care Medicine, vol. 37, no. 11, 2009, pp. 2867-74.
Renaud B, Santin A, Coma E, et al. Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. Crit Care Med. 2009;37(11):2867-74.
Renaud, B., Santin, A., Coma, E., Camus, N., Van Pelt, D., Hayon, J., Gurgui, M., Roupie, E., Hervé, J., Fine, M. J., Brun-Buisson, C., & Labarère, J. (2009). Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. Critical Care Medicine, 37(11), 2867-74. https://doi.org/10.1097/CCM.0b013e3181b02dbb
Renaud B, et al. Association Between Timing of Intensive Care Unit Admission and Outcomes for Emergency Department Patients With Community-acquired Pneumonia. Crit Care Med. 2009;37(11):2867-74. PubMed PMID: 19770748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. AU - Renaud,Bertrand, AU - Santin,Aline, AU - Coma,Eva, AU - Camus,Nicolas, AU - Van Pelt,Dave, AU - Hayon,Jan, AU - Gurgui,Merce, AU - Roupie,Eric, AU - Hervé,Jérôme, AU - Fine,Michael J, AU - Brun-Buisson,Christian, AU - Labarère,José, PY - 2009/9/23/entrez PY - 2009/9/23/pubmed PY - 2009/12/16/medline SP - 2867 EP - 74 JF - Critical care medicine JO - Crit Care Med VL - 37 IS - 11 N2 - OBJECTIVE: To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients). DESIGN: Secondary analysis of the original data from two North American and two European prospective, multicenter, cohort studies of adult patients with community-acquired pneumonia. PATIENTS: In all, 453 non-institutionalized patients transferred within 3 days of emergency department presentation to an intensive care unit were included in the analysis. Supplementary analysis was restricted to patients without an obvious indication for immediate transfer to an intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The sample consisted of 138 delayed-transfer and 315 direct-transfer patients, among whom 150 (33.1%) were considered to have an obvious indication for immediate intensive care unit admission. After adjusting for the quintile of propensity score, delayed intensive care unit transfer was associated with an increased odds ratio for 28-day mortality (2.07; 95% confidence interval, 1.12-3.85) and a decreased odds ratio for discharge from hospital for survivors (0.53; 95% confidence interval, 0.39-0.71). In a propensity-matched analysis, delayed-transfer patients had a higher 28-day mortality rate (23.4% vs. 11.7%; p = 0.02) and a longer median hospital length of stay (13 days vs. 7 days; p < .001) than direct-transfer patients. Similar results were found after excluding the 150 patients with an obvious indication for immediate intensive care unit admission. CONCLUSIONS: Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/19770748/Association_between_timing_of_intensive_care_unit_admission_and_outcomes_for_emergency_department_patients_with_community_acquired_pneumonia_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181b02dbb DB - PRIME DP - Unbound Medicine ER -