Bouneb Rania, Mellouli Menel, Dardouri Maha, Soltane Houda Ben, Chouchene Imed, Boussarsar Mohamed
Department of Intensive Care Unit, University Hospital of Farhat Hached, Susah Tunisia.
Department of Preventive Medicine, Faculty of Medicine, Susah Tunisia.
Pan Afr Med J. 2018 Mar 26;29:176. doi: 10.11604/pamj.2018.29.176.13099. eCollection 2018.
intensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few data regarding both outcomes of admitted patients to intensive care unit (ICU) in comparison with outcomes of not admitted patients. The aim of this study was to assess reasons and factors associated to refusal of admission to ICU as well as the impact on mortality at 28 days and patients' outcomes.
Single-center, cross-sectional descriptive study conducted in 8-bed Medical ICU at a Tunisian University hospital. All consecutive adult patients referred for admission to ICU during 6 months were included. We collected demographic data, ICU admission/refusal reasons, co-morbidity and diagnosis at time of admission, mortality probability model (MPMII0) score, day and time of admission, request for admission and mortality at 28 days.
327 patients were evaluated for ICU admission and 260 were refused to ICU (79.5%). Patients refused because of unavailability of beds represented 50% and patients considered "too sick to benefit" represented 22%. Multivariate analysis showed that the presence of acute respiratory failure and request by direct contact in the unit were independently associated to admission to ICU (OR: 0.15; 95% CI: 0.07-0.31 and OR: 0.16; 95% CI: 0.08-0.31, respectively). Higher mortality rates were shown in patients "too sick to benefit" (80.7%) and unavailable beds (26.56%).
Refusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. ICU clinicians should evaluate their triage decisions and, if possible, routinely solicit patient preferences during medical emergencies, taking steps to ensure that ICU admission decisions are in line with the goals of the patient. Ultimately, these efforts will help ensure that scarce ICU resources are used most effectively and efficiently.
重症监护病房（ICU）床位是一种稀缺资源，当需求超过供给时，入院可能需要进行优先级排序。然而，与未入住ICU的患者相比，关于入住ICU患者结局的数据较少。本研究的目的是评估拒绝入住ICU的原因和相关因素，以及对28天死亡率和患者结局的影响。
在突尼斯一家大学医院的8张床位的内科ICU进行单中心横断面描述性研究。纳入了6个月内所有连续转诊至ICU的成年患者。我们收集了人口统计学数据、ICU入院/拒绝原因、入院时的合并症和诊断、死亡概率模型（MPMII0）评分、入院日期和时间、入院请求以及28天死亡率。
327例患者接受了ICU入院评估，260例被拒绝入住ICU（79.5%）。因床位不可用而被拒绝的患者占50%，被认为“病情过重无法获益”的患者占22%。多因素分析显示，急性呼吸衰竭的存在和科室直接联系请求与入住ICU独立相关（OR分别为：0.15；95%CI：0.07 - 0.31和OR：0.16；95%CI：0.08 - 0.31）。“病情过重无法获益”的患者（80.7%）和床位不可用的患者（26.56%）死亡率较高。
拒绝入住ICU与急性疾病的严重程度、ICU床位短缺以及入院请求原因相关。ICU临床医生应评估他们的分诊决策，并在医疗紧急情况时尽可能常规征求患者偏好，采取措施确保ICU入院决策符合患者目标。最终，这些努力将有助于确保稀缺的ICU资源得到最有效和高效的利用。
