Observational studyCritical care medicine2020
Higher ICU Capacity Strain Is Associated With Increased Acute Mortality in Closed ICUs.
Observational study in Critical care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Pooled it
- Guideline
- Implementation and feasibility evaluation of a standard set of intensive care unit discharge criteria in a prospective before-after observational pilot study.BMC health services research · 2026Observational
- The association of NICU capacity strain with neonatal mortality and morbidity.Journal of perinatology : official journal of the California Perinatal Association · 2025Article
- An interpretable machine learning algorithm enables dynamic 48-hour mortality prediction during an ICU stay.Communications medicine · 2025Article
- The impact of intensive care strain on patients' outcomes-a multinational observational cohort (UNITE-COVID) study.Critical care (London, England) · 2025Observational
- Prevalence and Predictors of Home Discharge from the PICU.Critical care explorations · 2025Article
- Associations of hospital unit occupancy with inpatient falls and fall-risk assessment completion: a retrospective cohort study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2025Article
- Impact of the COVID-19 pandemic on brain death detection in German hospitals: a state-wide analysis of health data.Neurological research and practice · 2025Article
- Critical care resources in surge response: towards real-time situation awareness.Journal of the Royal Society of New Zealand · 2025Article
- Increased national critical care demands were associated with a higher mortality of intubated COVID-19 patients in Japan: a retrospective observational study.Journal of intensive care · 2024Article
- Intensive care unit caseload and workload and their association with outcomes in critically unwell patients: a large registry-based cohort analysis.Critical care (London, England) · 2024Article
- Inadequate intensive care physician supply in France: a point-prevalence prospective study.Annals of intensive care · 2024Article
- Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation.World journal of transplantation · 2024Article
- Article
- Forecasting ICU Census by Combining Time Series and Survival Models.Critical care explorations · 2023Article
- Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model: A Before-and-After Study.Critical care explorations · 2023Article
- The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.Health services research · 2022Article
- A critical care outreach team under strain - Evaluation of the service provided to patients with haematological malignancy during the Covid-19 pandemic.Journal of critical care · 2022Article
- Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID-19 pandemic in Victoria, Australia.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine whether patients admitted to an ICU during times of strain, when compared with its own norm (i.e. accommodating a greater number of patients, higher acuity of illness, or frequent turnover), is associated with a higher risk of death in ICUs with closed models of intensivist staffing.
designWe conducted a large, multicenter, observational cohort study. Multilevel mixed effects logistic regression was used to examine relationships for three measures of ICU strain (bed census, severity-weighted bed census, and activity-weighted bed census) on the day of admission with risk-adjusted acute hospital mortality.
settingPooled case mix and outcome database of adult general ICUs participating in the Intensive Care National Audit and Research Centre Case Mix Programme. MEASUREMENTS AND MAIN
resultsThe analysis included 149,310 patients admitted to 215 adult general ICUs in 213 hospitals in United Kingdom, Wales, and Northern Ireland. A relative lower strain in ICU capacity as measured by bed census on the calendar day (daytime hours) of admission was associated with decreased risk-adjusted acute hospital mortality (odds ratio, 0.94; 95% CI, 0.90-0.99; p = 0.01), whereas a nonsignificant association was seen between higher strain and increased acute hospital mortality (odds ratio, 1.04; 95% CI, 1.00-1.10; p = 0.07). The relationship between periods of high ICU strain and acute hospital mortality was strongest when bed census was composed of higher acuity patients (odds ratio, 1.05; 95% CI, 1.01-1.10; p = 0.03). No relationship was seen between high strain and ICU mortality.
conclusionsIn closed staffing models of care, variations in bed census within individual ICUs was associated with patient's predicted risk of acute hospital mortality, particularly when its standardized bed census consisted of sicker patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.