ArticleCritical care medicine2018
The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying.
Article in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Effectiveness and Cost Analysis of Implementation of Tele-ICU: A Multicenter Administrative Database Study Using Interrupted Time-Series Analysis Within a University-Affiliated Hospital Network.Journal of clinical medicine · 2026Article
- Evaluation of Interruptions During IV Smart Pump Medication Administration in Intensive Care Units.Journal of patient safety · 2026Observational
- SWEAT ICU-An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs.Critical care explorations · 2022Article
- Domain Adaptation Using Convolutional Autoencoder and Gradient Boosting for Adverse Events Prediction in the Intensive Care Unit.Frontiers in artificial intelligence · 2022Article
- Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment.AACN advanced critical care · 2021Article
- Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic : A retrospective propensity score-matched analysis.Wiener klinische Wochenschrift · 2021Article
- Advances in Non-Invasive Blood Pressure Monitoring.Sensors (Basel, Switzerland) · 2021Review
- Pediatric Critical Care in Resource Limited Settings-Lessening the Gap Through Ongoing Collaboration, Advancement in Research and Technological Innovations.Frontiers in pediatrics · 2021Review
- Do the Right Thing.Chest · 2020Article
- ICU beds: less is more? No.Intensive care medicine · 2020Article
- Article
- Development and validation of delirium prediction model for critically ill adults parameterized to ICU admission acuity.PloS one · 2020Article
- The relationship between hospital case mix, academic affiliation, program size, and American Board of Internal Medicine examination pass rates.Proceedings (Baylor University. Medical Center)Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
objectiveMany ICU patients do not require critical care interventions. Whether aggressive care environments increase risks to low-acuity patients is unknown. We evaluated whether ICU acuity was associated with outcomes of low mortality-risk patients. We hypothesized that admission to high-acuity ICUs would be associated with worse outcomes. This hypothesis was based on two possibilities: 1) high-acuity ICUs may have a culture of aggressive therapy that could lead to potentially avoidable complications and 2) high-acuity ICUs may focus attention toward the many sicker patients and away from the fewer low-risk patients.
designRetrospective cohort study.
settingThree hundred twenty-two ICUs in 199 hospitals in the Philips eICU database between 2010 and 2015. PATIENTS: Adult ICU patients at low risk of dying, defined as an Acute Physiology and Chronic Health Evaluation-IVa-predicted mortality of 3% or less. EXPOSURE: ICU acuity, defined as the mean Acute Physiology and Chronic Health Evaluation IVa score of all admitted patients in a calendar year, stratified into quartiles. MEASUREMENTS AND MAIN
resultsWe used generalized estimating equations to test whether ICU acuity is independently associated with a primary outcome of ICU length of stay and secondary outcomes of hospital length of stay, hospital mortality, and discharge destination. The study included 381,997 low-risk patients. Mean ICU and hospital length of stay were 1.8 ± 2.1 and 5.2 ± 5.0 days, respectively. Mean Acute Physiology and Chronic Health Evaluation IVa-predicted hospital mortality was 1.6% ± 0.8%; actual hospital mortality was 0.7%. In adjusted analyses, admission to low-acuity ICUs was associated with worse outcomes compared with higher-acuity ICUs. Specifically, compared with the highest-acuity quartile, ICU length of stay in low-acuity ICUs was increased by 0.24 days; in medium-acuity ICUs by 0.16 days; and in high-acuity ICUs by 0.09 days (all p < 0.001). Similar patterns existed for hospital length of stay. Patients in lower-acuity ICUs had significantly higher hospital mortality (odds ratio, 1.28 [95% CI, 1.10-1.49] for low-; 1.24 [95% CI, 1.07-1.42] for medium-, and 1.14 [95% CI, 0.99-1.31] for high-acuity ICUs) and lower likelihood of discharge home (odds ratio, 0.86 [95% CI, 0.82-0.90] for low-, 0.88 [95% CI, 0.85-0.92] for medium-, and 0.95 [95% CI, 0.92-0.99] for high-acuity ICUs).
conclusionsAdmission to high-acuity ICUs is associated with better outcomes among low mortality-risk patients. Future research should aim to understand factors that confer benefit to patients with different risk profiles.
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