Population-based epidemiology of intensive care: critical importance of ascertainment of residency statusReportar como inadecuado




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Critical Care

, 8:R431

First Online: 15 October 2004Received: 26 April 2004Revised: 09 July 2004Accepted: 05 August 2004

Abstract

IntroductionFew studies evaluating the epidemiology of critical illness have used strict population-based designs that exclude subjects external to the base population. The objective of this study was to evaluate the potential effects of inclusion of nonresidents in population-based studies in intensive care.

MethodsA population-based cohort study including all adults admitted to Calgary Health Region CHR multidisciplinary and cardiovascular surgical intensive care units ICUs between 1 May 1999 and 30 April 2003 was conducted. A comparison of patients resident and nonresident in the base population was then performed.

ResultsA total of 12,193 adult patients had at least one admission to an ICU; 7767 63.7% were CHR residents, for an incidence of 263.7 per 100,000 per year. Male CHR residents were at significant increased risk for ICU admission as compared with females 330.5 per 100,000 versus 198.2 per 100,000; relative risk, 1.67; 95% confidence interval, 1.59–1.74; P < 0.0001, as were CHR residents aged 65 years and older as compared with younger patients 1719.9 per 100,000 versus 238.7 per 100,000; relative risk, 7.21; 95% confidence interval, 6.95–7.47; P < 0.0001. The mortality rate was significantly lower among non-CHR residents 12.7% as compared with CHR residents 20.0%; P < 0.0001. Logistic regression modeling identified CHR residency as an independent risk factor for death odds ratio, 1.4; 95% confidence interval, 1.2–1.5; P < 0.0001.

ConclusionThis study provides information on the incidence of and demographic risk factors for admission to ICUs in a defined population. Inclusion of patients that are nonresident in base study populations may lead to gross errors in determination of the occurrence and outcomes of critical illness.

Keywordsincidence intensive care unit mortality population-based AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation

CHRCalgary Health Region

CIconfidence interval

CVICUcardiovascular surgery intensive care unit

ICUintensive care unit

IQRinterquartile range

RRrelative risk

SIRSsystemic inflammatory response syndrome.

Electronic supplementary materialThe online version of this article doi:10.1186-cc2947 contains supplementary material, which is available to authorized users.

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Autor: Kevin B Laupland

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







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