ArticleIntensive care medicine2018
Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain.
Article in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed.
- Early detection and treatment of acute illness in medical patients with novel software: a prospective quality improvement initiative.BMJ open quality · 2022Trial
- Delayed Admission to the Intensive Care Unit Is Associated With Increased Mortality Risk in Critically Ill Patients: A Prospective Cohort Study.Journal of advanced nursing · 2026Article
- Intensive care patients eligible for intermediate care unit-level care: a single-centre prospective cohort study in Belgium.Critical care science · 2026Article
- Emergency critical care: closing the gap between onset of critical illness and intensive care unit admission.Wiener klinische Wochenschrift · 2024Review
- Early Warning Systems for Critical Illness Outside the Intensive Care Unit.Critical care clinics · 2024Review
- Article
- Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study.Journal of intensive care · 2023Article
- Mortality analysis among sepsis patients in and out of intensive care units using the Japanese nationwide medical claims database: a study by the Japan Sepsis Alliance study group.Journal of intensive care · 2023Article
- Article
- Mortality trends and length of stays among hospitalized patients with COVID-19 in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2022Article
- Dopamine use and its consequences in the intensive care unit: a cohort study utilizing the Japanese Intensive care PAtient Database.Critical care (London, England) · 2022Article
- Association of ICU Admission and Outcomes in Sepsis and Acute Respiratory Failure.American journal of respiratory and critical care medicine · 2022Article
- A hybrid Neural Network-SEIR model for forecasting intensive care occupancy in Switzerland during COVID-19 epidemics.PloS one · 2022Article
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.Intensive care medicine · 2021Article
- Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK.The Lancet. Respiratory medicine · 2021Observational
- Increased time from physiological derangement to critical care admission associates with mortality.Critical care (London, England) · 2021Article
- Discrete-Event Simulation Modeling of Critical Care Flow: New Hospital, Old Challenges.Critical care explorations · 2020Article
- ICU beds: less is more? Not sure.Intensive care medicine · 2020Article
- Focus on the frail and elderly: who should have a trial of ICU treatment?Intensive care medicine · 2020Article
- Near-simultaneous intensive care unit (ICU) admissions and all-cause mortality: a cohort study.Intensive care medicine · 2019Article
Corrections and comments
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- Erratum issued
Authors and funding
6 authors.
Funding
Abstract
purposeTo estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients.
methodsWe performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high (2+, 1 or 0 empty beds). This instrumental variable (IV) analysis was repeated for the subgroup of referrals with a recommendation for critical care once assessed. Risk-adjusted 90-day survival models were also constructed.
resultsA total of 12,380 patients from 48 hospitals were available for analysis. There were 2411 (19%) prompt admissions (median delay 1 h, IQR 1-2) and 9969 (81%) controls; 1990 (20%) controls were admitted later (median delay 11 h, IQR 6-26). Prompt admissions were less frequent (p < 0.0001) as strain increased from low (22%), to medium (15%) to high (9%); the median delay to admission was 3, 4 and 5 h respectively. In the IV analysis, prompt admission reduced 90-day mortality by 7.4% (95% CI 1.7-18.5%, p = 0.117) overall, and 16.2% (95% CI 1.1-31.3%, p = 0.036) for those recommended for critical care. In the risk-adjust survival model, 90-day mortality was similar.
conclusionAfter allowing for unobserved prognostic differences between the groups, we find that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.
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