A meta-analysis to derive literature-based benchmarks for readmission and hospital mortality after patient discharge from intensive careReportar como inadecuado




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Critical Care

, 18:715

First Online: 31 December 2014Received: 01 October 2014Accepted: 10 December 2014

Abstract

IntroductionWe sought to derive literature-based summary estimates of readmission to the ICU and hospital mortality among patients discharged alive from the ICU.

MethodsWe searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from inception to March 2013, as well as the reference lists in the publications of the included studies. We selected cohort studies of ICU discharge prognostic factors that in which readmission to the ICU or hospital mortality among patients discharged alive from the ICU was reported. Two reviewers independently abstracted the number of patients readmitted to the ICU and hospital deaths among patients discharged alive from the ICU. Fixed effects and random effects models were used to estimate the pooled cumulative incidence of ICU readmission and the pooled cumulative incidence of hospital mortality.

ResultsThe analysis included 58 studies n = 2,073,170 patients. The majority of studies followed patients until hospital discharge n = 46 studies and reported readmission to the ICU n = 46 studies or hospital mortality n = 49 studies. The cumulative incidence of ICU readmission was 4.0 readmissions 95% confidence interval CI, 3.9 to 4.0 per 100 patient discharges using fixed effects pooling and 6.3 readmissions 95% CI, 5.6 to 6.9 per 100 patient discharges using random effects pooling. The cumulative incidence of hospital mortality was 3.3 deaths 95% CI, 3.3 to 3.3 per 100 patient discharges using fixed effects pooling and 6.8 deaths 95% CI, 6.1 to 7.6 per 100 patient discharges using random effects pooling. There was significant heterogeneity for the pooled estimates, which was partially explained by patient, institution and study methodological characteristics.

ConclusionsUsing current literature estimates, for every 100 patients discharged alive from the ICU, between 4 and 6 patients on average will be readmitted to the ICU and between 3 and 7 patients on average will die prior to hospital discharge. These estimates can inform the selection of benchmarks for quality metrics of transitions of patient care between the ICU and the hospital ward.

AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation

APSAcute Physiology Score

CIConfidence interval

DNRDo not resuscitate

ICUIntensive care unit

MICUMedical intensive care unit

MPMO-IIIMortality Probability Admission Model

NICUNeurosurgical intensive care unit

SAPSSimplified Acute Physiology Score

SICUSurgical intensive care unit

SOISeverity of illness

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0715-6 contains supplementary material, which is available to authorized users.

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Autor: F Shaun Hosein - Derek J Roberts - Tanvir Chowdhury Turin - David Zygun - William A Ghali - Henry T Stelfox

Fuente: https://link.springer.com/







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