Khanna Ashish K, Moucharite Marilyn A, Benefield Patrick J, Kaw Roop
Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Outcomes Research Consortium, Cleveland, OH, USA.
Clinicoecon Outcomes Res. 2023 Sep 25;15:703-719. doi: 10.2147/CEOR.S424759. eCollection 2023.
To characterize medical and surgical patient characteristics, as well as clinical and economic outcomes, associated with unplanned intensive care unit (ICU) admissions.
This was a retrospective matched cohort analysis that utilized the PINC AI Healthcare Database, which collects deidentified data from 25% of United States (US) hospital admissions. Discharge records were assessed for medical and surgical admissions in 2021. An unplanned ICU admission was defined as direct transfer from a medical, surgical, or telemetry unit to the ICU. Patients with and without an unplanned ICU admission were 1:1 propensity score matched. Differences between patients with and without unplanned ICU admissions were assessed using two-sample -tests for continuous measures and Chi-square tests for categorical measures.
A total of 3,807,124 qualifying admissions were identified. Medical admissions with unplanned ICU transfers were more likely to be urgent/emergent (odds ratio [OR] 2.9, 95% confidence interval [CI 2.7-3.0], p<0.0001), with patient characteristics including male sex (1.4, [1.4-1.4], p<0.0001), obesity (1.7, [1.6-1.7], p<0.0001), and increased Charlson Comorbidity Index (CCI=1: 1.8, [1.8-1.9], p<0.0001; CCI≥5: 3.2, [3.1-3.3], p<0.0001). Surgical admissions with unplanned ICU transfers were more likely to be urgent/emergent (3.1, [2.9-3.2], p<0.0001) and with patients of higher CCI (2.5, [2.3-2.6], p<0.0001 to a CCI of≥5 (7.9, [7.4-8.4], p<0.0001). Between matched medical patients, mean differences in length of stay, cost, and mortality were 4.1 days (p<0.0001), $13,424 (p<0.0001), and 21% (p<0.0001), respectively. Between matched surgical patients, mean differences in these outcomes were 6.4 days (p<0.0001), $21,448 (p<0.0001), and 14% (p<0.0001), respectively.
Emergency care in patients with a higher co-morbid burden is more likely to lead to unplanned ICU admission, putting patients at a significantly increased chance of mortality, longer length of stay, and increased costs. Improving care and monitoring of patients outside the ICU may help detect early changes in pathophysiology and enable early intervention.
描述与非计划重症监护病房（ICU）入院相关的内科和外科患者特征以及临床和经济结局。
这是一项回顾性匹配队列分析，利用了PINC AI医疗保健数据库，该数据库收集了美国25%住院患者的去识别数据。对2021年内科和外科住院患者的出院记录进行评估。非计划ICU入院定义为从内科、外科或遥测病房直接转入ICU。有无非计划ICU入院的患者按1:1倾向评分匹配。采用两样本t检验评估连续变量，采用卡方检验评估分类变量，以比较有无非计划ICU入院患者之间的差异。
共识别出3807124例符合条件的住院病例。内科患者非计划转入ICU更可能是紧急/急诊情况（优势比[OR]2.9，95%置信区间[CI]2.7 - 3.0，p<0.0001），患者特征包括男性（1.4，[1.4 - 1.4]，p<0.0001）、肥胖（1.7，[1.6 - 1.7]，p<0.0001）以及Charlson合并症指数升高（CCI = 1: 1.8，[1.8 - 1.9]，p<0.0001；CCI≥5: 3.2，[3.1 - 3.3]，p<0.0001）。外科患者非计划转入ICU更可能是紧急/急诊情况（3.1，[2.9 - 3.2]，p<0.0001），且CCI较高（2.5，[2.3 - 2.6]，p<0.0001），CCI≥5时更高（7.9，[7.4 - 8.4]，p<0.0001）。在匹配的内科患者中，住院时间、费用和死亡率的平均差异分别为4.1天（p<0.0001）、13424美元（p<0.0001）和21%（p<0.0001）。在匹配的外科患者中，这些结局的平均差异分别为6.4天（p<0.0001）、21448美元（p<0.0001）和14%（p<0.0001）。
合并症负担较高的患者接受急诊治疗更易导致非计划ICU入院，使患者死亡风险显著增加，并延长住院时间、增加费用。改善ICU外患者的护理和监测可能有助于发现病理生理学的早期变化并实现早期干预。
