ArticleIntensive care medicine2022
Variation in severity-adjusted resource use and outcome in intensive care units.
Article in Intensive care medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Interpretable Machine Learning for In-Hospital Mortality Prediction in ICU Patients Using First-24-Hour Routine Vital Signs: A SHAP-Based MIMIC-IV Study.Diagnostics (Basel, Switzerland) · 2026Article
- Benchmarking and efficiency assessment in intensive care units: a systematic review protocol.Critical care science · 2026Article
- Risk stratification and determinant identification of high-need, high-cost ICU patients using machine learning: a large-scale retrospective study from a multi-specialty ICU in a tertiary hospital.Frontiers in public health · 2026Article
- EPOS-OHCA: Early Predictors of Outcome and Survival after non-traumatic Out-of-Hospital Cardiac Arrest.Resuscitation plus · 2024Article
- Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement.Journal of critical care · 2024Article
- Variation in Severity-Adjusted Resource use and Outcome for Neurosurgical Emergencies in the Intensive Care Unit.Neurocritical care · 2024Article
- Modelling of intensive care unit (ICU) length of stay as a quality measure: a problematic exercise.BMC medical research methodology · 2023Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIntensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure.
methodsData of 207,131 patients treated in 2008-2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015-2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015-2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models.
resultsSMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5-5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR.
conclusionThe wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.
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