ArticleAnnals of intensive care2021
Outcome of cancer patients considered for intensive care unit admission in two university hospitals in the Netherlands: the danger of delayed ICU admissions and off-hour triage decisions.
Article in Annals of intensive care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 22 citations in OpenAlex.
- Dynamic changes in mortality risk factors for acute leukemia patients in the ICU and Post-ICU periods.Annals of hematology · 2026Article
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- Neutropenic sepsis and septic shock in ICU patients: A single-center experience over the last decade.PloS one · 2025Article
- Outcome of patients with solid malignancies considered for intensive care unit admission: a single-center prospective cohort study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- Septic shock in the immunocompromised cancer patient: a narrative review.Critical care (London, England) · 2024Review
- [With a tumor diagnosis in the intensive care unit].Innere Medizin (Heidelberg, Germany) · 2023Review
- Triage of Critically Ill Patients: Characteristics and Outcomes of Patients Refused as Too Well for Intensive Care.Journal of clinical medicine · 2023Article
- A clinically applicable prediction model for the risk of in-hospital mortality in solid cancer patients admitted to intensive care units with sepsis.Journal of cancer research and clinical oncology · 2023Article
- Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients.Internal and emergency medicine · 2023Article
- Etiologies and Outcome of Patients with Solid Tumors Admitted to ICU with Acute Respiratory Failure: A Secondary Analysis of the EFRAIM Study.Respiratory care · 2023Article
- Outcomes and Prognostic Factors in Critical Patients with Hematologic Malignancies.Journal of clinical medicine · 2023Article
- 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
- Interpretable early mortality prediction in oncology ICU patients: A dual-cohort validation of a LASSO-XGBoost-SHAP framework.Digital healthArticle
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Authors and funding
7 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVery few studies assessed the association between Intensive Care Unit (ICU) triage decisions and mortality. The aim of this study was to assess whether an association could be found between 30-day mortality, and ICU admission consultation conditions and triage decisions.
methodsWe conducted a retrospective cohort study in two large referral university hospitals in the Netherlands. We identified all adult cancer patients for whom ICU admission was requested from 2016 to 2019. Via a multivariable logistic regression analysis, we assessed the association between 30-day mortality, and ICU admission consultation conditions and triage decisions.
resultsOf the 780 cancer patients for whom ICU admission was requested, 332 patients (42.6%) were considered 'too well to benefit' from ICU admission, 382 (49%) patients were immediately admitted to the ICU and 66 patients (8.4%) were considered 'too sick to benefit' according to the consulting intensivist(s). The 30-day mortality in these subgroups was 30.1%, 36.9% and 81.8%, respectively. In the patient group considered 'too well to benefit', 258 patients were never admitted to the ICU and 74 patients (9.5% of the overall study population, 22.3% of the patients 'too well to benefit') were admitted to the ICU after a second ICU admission request (delayed ICU admission). Thirty-day mortality in these groups was 25.6% and 45.9%. After adjustment for confounders, ICU consultations during off-hours (OR 1.61, 95% CI 1.09-2.38, p-value 0.02) and delayed ICU admission (OR 1.83, 95% CI 1.00-3.33, p-value 0.048 compared to "ICU admission") were independently associated with 30-day mortality.
conclusionThe ICU denial rate in our study was high (51%). Sixty percent of the ICU triage decisions in cancer patients were made during off-hours, and 22.3% of the patients initially considered "too well to benefit" from ICU admission were subsequently admitted to the ICU. Both decisions during off-hours and a delayed ICU admission were associated with an increased risk of death at 30 days. Our study suggests that in cancer patients, ICU triage decisions should be discussed during on-hours, and ICU admission policy should be broadened, with a lower admission threshold for critically ill cancer patients.
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