比较美国和英国的重症监护病房的医疗入院情况。

Comparison of medical admissions to intensive care units in the United States and United Kingdom.

机构信息

Department of Anesthesiology, Columbia University, New York, New York, USA.

出版信息

Am J Respir Crit Care Med. 2011 Jun 15;183(12):1666-73. doi: 10.1164/rccm.201012-1961OC. Epub 2011 Mar 25.

DOI:10.1164/rccm.201012-1961OC

PMID:21471089

Abstract

RATIONALE

The United States has seven times as many intensive care unit (ICU) beds per capita as the United Kingdom; the effect on care of critically ill patients is unknown.

OBJECTIVES

To compare medical ICU admissions in the United States and United Kingdom.

METHODS

Retrospective (2002-2004) cohort study of 172,785 ICU admissions (137 United States ICUs, Project IMPACT database; 160 United Kingdom ICUs, Case Mix Program) with patients followed until initial hospital discharge.

MEASUREMENT AND MAIN RESULTS

United Kingdom (vs. United States) admissions were less likely to be admitted directly from the emergency room (ER) (33.4% vs. 58%); had longer hospital stays before ICU admission (mean days 2.6 ± 8.2 vs. 1 ± 3.6); and fewer were greater than or equal to 85 years (3.2% vs. 7.8%). United Kingdom patients were more frequently mechanically ventilated within 24 hours after ICU admission (68% vs. 27.4%); were sicker (mean Acute Physiology Score 16.7 ± 7.6 vs. 10.6 ± 6.8); and had higher primary hospital mortality (38% vs. 15.9%; adjusted odds ratio, 1.73; 95% confidence interval, 1.50-1.99). There was no mortality difference for mechanically ventilated patients admitted from the ER (adjusted odds ratio, 1.09; 95% confidence interval, 0.89-1.33). Comparisons of hospital mortality were confounded by differences in case mix; hospital length of stay (United Kingdom median 10 d [interquartile range {IQR}, 3-24] vs. United States 6 d [IQR, 3-11]; and discharge practices (more United States patients were discharged to skilled care facilities [29% of survivors vs. 6% in the United Kingdom]).

CONCLUSIONS

Lower United Kingdom ICU bed availability is associated with fewer direct admissions from the ER, longer hospital stays before ICU admission, and higher severity of illness. Interpretation of between-country hospital outcomes is confounded by differences in case mix, processes of care, and discharge practices.

摘要

背景

美国的重症加强护理病房（ICU）床位数量是英国的七倍；但 ICU 床位数量对危重病患者护理的影响尚不清楚。

目的

比较美国和英国的 ICU 收治情况。

方法

回顾性队列研究（2002-2004 年）纳入 172785 例 ICU 收治患者（美国 137 家 ICU，IMPACT 项目数据库；英国 160 家 ICU，病例组合程序），患者均随访至首次出院。

测量和主要结果

与美国相比，英国 ICU 收治患者更不可能直接从急诊室（ER）收治（33.4% vs. 58%）；在 ICU 收治前有更长的住院时间（平均 2.6 ± 8.2 天 vs. 1 ± 3.6 天）；≥85 岁的患者比例更少（3.2% vs. 7.8%）。英国 ICU 收治患者在 ICU 收治后 24 小时内更频繁地接受机械通气（68% vs. 27.4%）；病情更重（平均急性生理学评分 16.7 ± 7.6 分 vs. 10.6 ± 6.8 分）；且初级医院死亡率更高（38% vs. 15.9%；校正比值比，1.73；95%置信区间，1.50-1.99）。对于从 ER 收治的接受机械通气的患者，死亡率没有差异（校正比值比，1.09；95%置信区间，0.89-1.33）。由于病例组合的差异，医院死亡率的比较受到混杂因素影响；住院时间（英国中位数 10 d [四分位距 {IQR}，3-24] vs. 美国 6 d [IQR，3-11]）和出院实践（更多的美国患者被转至康复护理机构[存活者的 29% vs. 英国的 6%]）。