Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA.
J Hosp Med. 2012 Mar;7(3):224-30. doi: 10.1002/jhm.964. Epub 2011 Oct 28.
Patients with intensive care unit (ICU) transfers from hospital wards have higher mortality than those directly admitted from the emergency department.
To describe the association between the timing of unplanned ICU transfers and hospital outcomes.
DESIGN, SETTING, PATIENTS: Evaluation of 6369 early (within 24 hours of hospital admission) unplanned ICU transfer cases and matched directly admitted ICU controls from an integrated healthcare system. Cohorts were matched by predicted mortality, age, gender, diagnosis, and admission characteristics. Hospital mortality of cases and controls were compared based on elapsed time and diagnosis.
More than 5% of patients admitted through the emergency department experienced an unplanned ICU transfer; the incidence and rates of transfers were highest within the first 24 hours of hospitalization. Multivariable matching produced 5839 (92%) case-control pairs. Median length of stay was higher among cases (5.0 days) than controls (4.1 days, P < 0.01); mortality was also higher among cases (11.6%) than controls (8.5%, P < 0.01). Patients with early unplanned transfers were at an increased risk of death (odds ratio, 1.44; 95% confidence interval, 1.26-1.64; P < 0.01); an increased risk of death was observed even among patients transferred within 8 hours of hospitalization. Hospital mortality differed based on admitting diagnosis categories. While it was higher among cases admitted for respiratory infections and gastrointestinal bleeding, it was not different for those with acute myocardial infarction, sepsis, and stroke.
Early unplanned ICU transfers-even within 8 hours of hospitalization-are associated with increased mortality; outcomes vary by elapsed time to transfer and admitting diagnosis.
从医院病房转入重症监护病房（ICU）的患者比直接从急诊科转入的患者死亡率更高。
描述 ICU 计划外转科时间与医院结局之间的关联。
设计、地点、患者：评估了来自综合医疗系统的 6369 例早期（入院后 24 小时内）计划外 ICU 转科病例和匹配的直接收入 ICU 对照组。通过预测死亡率、年龄、性别、诊断和入院特征对队列进行匹配。根据时间流逝和诊断比较病例和对照组的住院死亡率。
超过 5%通过急诊入院的患者经历了计划外 ICU 转科；转科的发生率和转科率在入院后的前 24 小时内最高。多变量匹配产生了 5839 对（92%）病例对照。病例的中位住院时间（5.0 天）长于对照组（4.1 天，P < 0.01）；病例的死亡率（11.6%）也高于对照组（8.5%，P < 0.01）。早期计划外转科患者的死亡风险增加（优势比，1.44；95%置信区间，1.26-1.64；P < 0.01）；即使在入院 8 小时内转科的患者中，也观察到死亡风险增加。住院死亡率因入院诊断类别而异。虽然因呼吸道感染和胃肠道出血入院的患者死亡率较高，但因急性心肌梗死、败血症和中风入院的患者死亡率没有差异。
即使在入院 8 小时内，早期计划外 ICU 转科也与死亡率增加相关；结局因转科时间和入院诊断而异。
