Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort studyReport as inadecuate

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Critical Care

, 18:551

First Online: 09 October 2014Received: 12 February 2014Accepted: 23 September 2014


IntroductionThe aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units ICU and Intermediate Care Units IMCU have lower in-hospital mortality than those admitted to ICUs without an IMCU.

MethodsAn observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge censored at 90 days.

ResultsOne hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 19.1% patients died in the ICU and 1,397 died in hospital, with a total of 1,397 23.9% deaths. The illness severity was higher for patients in ICUs with an IMCU median Simplified Acute Physiology Score SAPS II: 37 than for patients in ICUs without an IMCU median SAPS II: 29, P <0.001. After adjustment for patient characteristics at admission such as illness severity, and ICU and hospital characteristics, the odds ratio of mortality was 0.63 95% CI 0.45 to 0.88, P = 0.007 in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630 but was strong in patients admitted to an ICU for other reasons odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002.

ConclusionsThe presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment.

Trial NCT01422070. Registered 19 August 2011.

AbbreviationsCCCCoordination and Communications Centre

GEEgeneralized estimating equation

ICUIntensive Care Unit

IMCUIntermediate Care Unit

LOCLevel of Care

NEMSnine equivalents of nursing manpower use score nursing workload index

SAPSsimplified acute physiology score

SOFAsequential organ failure assessment

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0551-8 contains supplementary material, which is available to authorized users.

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Author: Maurizia Capuzzo - Carlo Alberto Volta - Tania Tassinati - Rui Paulo Moreno - Andreas Valentin - Bertrand Guidet - Gaetano


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