Thibault G E, Mulley A G, Barnett G O, Goldstein R L, Reder V A, Sherman E L, Skinner E R
N Engl J Med. 1980 Apr 24;302(17):938-42. doi: 10.1056/NEJM198004243021703.
To evaluate current practices regarding intensive-care units (ICU's), we collected data on 2693 consecutive admissions to a medical ICU during a two-year period and studied indications for admission, specific interventions, costs, and outcomes. The need for noninvasive monitoring rather than immediate major interventions prompted 77 per cent of the admissions. Only 10 per cent of monitored patients had subsequent indications for major interventions. The 23 per cent who required immediate interventions accounted for disproportionate shares of total charges (37 per cent) and deaths during hospitalization (58 per cent). Demographic and diagnostic data indicate that the aged and chronically ill have become the principal consumers of intensive care. Overall mortality during hospitalization was 10 per cent; cumulative mortality during follow-up study (mean duration, 15 months) was 25 per cent. We conclude that identification of sensitive predictors of complications and specific predictors of mortality can lead to more efficient and effective ICU practices.
为评估重症监护病房（ICU）的当前使用情况，我们收集了某内科ICU在两年期间连续收治的2693例患者的数据，并研究了入院指征、具体干预措施、费用及治疗结果。77%的患者入院是因为需要无创监测而非立即进行重大干预。在接受监测的患者中，仅有10%随后出现了进行重大干预的指征。需要立即进行干预的那23%的患者，在总费用（占37%）和住院期间死亡人数（占58%）中所占比例过高。人口统计学和诊断数据表明，老年人和慢性病患者已成为重症监护的主要使用者。住院期间的总体死亡率为10%；随访研究期间（平均时长15个月）的累积死亡率为25%。我们得出结论，识别并发症的敏感预测因素和死亡率的具体预测因素可带来更高效的ICU诊疗实践。
