Messer Ben, Harrison Emily, Carter Alison, Clement Ian, Gillott Holly, Ho Ching Khai, Ross Thomas, Lane Nicholas, Tedd Hilary
North East Assisted Ventilation Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Department of Critical Care Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
J Intensive Care Soc. 2024 Dec 2;26(1):61-67. doi: 10.1177/17511437241301922. eCollection 2025 Feb.
People with learning disabilities experience worse healthcare outcomes than the general population. There is evidence that they are more likely to experience avoidable mortality and less likely to receive critical care interventions during an acute illness. Decisions regarding critical care admission or intervention must be based on evidence of whether a patient will receive lasting benefit from a critical care admission. We therefore investigated outcomes from critical care admissions in people with learning disabilities and compared them to general critical care patients.
People with learning disabilities who were admitted to our critical care unit were identified via our coding department, from the Intensive Care National Audit and Research Centre (ICNARC) database and from our local electronic patient record. Mortality and length of stay outcomes for people with learning disabilities were recorded following critical care admission over a 5 years period and compared with the general critical care cohort over the same 5 years period. Longer term survival of patients with learning disabilities was also recorded.
297 critical care admissions in 176 people with learning disabilities were identified. The general critical care cohort included 6224 admissions in 4976 patients. The standardised mortality rate in people with learning disabilities admitted to critical care was 0.59 compared to the general critical care cohort which was 0.98. Mortality outcomes remained better in patients with learning disabilities compared to the general critical care cohort in invasively ventilated patients and in people with profound and multiple learning disability. Critical care length of stay was longer in people with learning disabilities. 12 month mortality was 14.8% in the learning disability cohort. By the end of the study, 23.9% of people with learning disabilities had died after a mean of 482 days following their first critical care admission. Patients who are currently still alive after having survived to hospital discharge following critical care admission have lived an average of 1129 days. After only 7.4% of critical care admissions in people with learning disabilities was there an increase in dependence on assistance in activities of daily living.
We have shown that people with learning disabilities are more likely to survive following a critical care admission than general critical care patients. This is regardless of whether they were invasively ventilated or whether they had profound and multiple learning disabilities. Critical care admission and invasive ventilation are associated with good short and longer term mortality.
学习障碍患者的医疗保健结果比普通人群更差。有证据表明，他们更有可能经历可避免的死亡，并且在急性疾病期间接受重症监护干预的可能性较小。关于重症监护入院或干预的决定必须基于患者是否会从重症监护入院中获得持久益处的证据。因此，我们调查了学习障碍患者重症监护入院的结果，并将其与普通重症监护患者进行了比较。
通过我们的编码部门、重症监护国家审计和研究中心（ICNARC）数据库以及我们当地的电子病历，确定入住我们重症监护病房的学习障碍患者。记录学习障碍患者在5年期间重症监护入院后的死亡率和住院时间结果，并与同一5年期间的普通重症监护队列进行比较。还记录了学习障碍患者的长期生存率。
确定了176名学习障碍患者的297次重症监护入院。普通重症监护队列包括4976名患者的6224次入院。入住重症监护的学习障碍患者的标准化死亡率为0.59，而普通重症监护队列的标准化死亡率为0.98。与普通重症监护队列相比，学习障碍患者在有创通气患者以及患有严重和多重学习障碍的患者中的死亡率结果仍然更好。学习障碍患者的重症监护住院时间更长。学习障碍队列中的12个月死亡率为14.8%。到研究结束时，23.9%的学习障碍患者在首次重症监护入院后的平均482天死亡。重症监护入院后存活至出院的患者目前仍存活，平均存活了1129天。学习障碍患者中只有7.4%的重症监护入院后日常生活活动对援助的依赖增加。
我们已经表明，学习障碍患者在重症监护入院后比普通重症监护患者更有可能存活。这与他们是否接受有创通气或是否患有严重和多重学习障碍无关。重症监护入院和有创通气与良好的短期和长期死亡率相关。
