ArticleCritical care (London, England)2025
In-hospital mortality of patients admitted to the intermediate care unit in hospitals with and without an intensive care unit: a nationwide inpatient database study.
Article in Critical care (London, England), 2025. 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.
- Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective.Acta paediatrica (Oslo, Norway : 1992) · 2026Review
- National cost of intensive care in Japan from 2018 to 2022.Journal of intensive care · 2026Article
- Intensive care patients eligible for intermediate care unit-level care: a single-centre prospective cohort study in Belgium.Critical care science · 2026Article
- Predictors of and hospital-level variation in intensive care unit readmissions in Japan: a nationwide inpatient database study.Journal of intensive care · 2025Article
- Intermediate Care Unit performance being properly assessed?Critical care (London, England) · 2025Article
- Intermediate Care Units in Europe and Italy: A Review of Structure, Outcomes, and Policy Implications for Internal Medicine.Journal of clinical medicine · 2025Review
- Timing of onset of persistent critical illness in Japan: a nationwide registry study.The Lancet regional health. Western Pacific · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundIntermediate care units (IMCUs) provide care for patients who need more intensive treatment than general wards but less than intensive care units (ICUs). Although the concept of an IMCU requires co-location with an ICU, some hospitals have IMCUs but no ICUs, which potentially worsens patient outcomes. This study aimed to examine the annual trends and care processes, and compare the outcomes of patients admitted to IMCUs in hospitals with and without ICUs using a nationwide inpatient database in Japan.
methodsThis retrospective cohort study was conducted from 2016 to 2022 using the Diagnosis Procedure Combination Database and Hospital Bed Function Reports in Japan. The main exposure was admission to the IMCU in hospitals with and without ICUs. The primary outcome was in-hospital mortality rate in hospitals with and without ICUs that were compared using multilevel logistic regression models adjusted for confounders.
resultsThe number of IMCU beds in hospitals without ICUs increased by 59% from 3,388 in 2016 to 5,403 in 2022, and the IMCU beds in hospitals without ICUs represented 38% (n = 5,403/14,185) of all IMCU beds in Japan in 2022. Among the 3,061,960 eligible patients in the IMCUs, 2,296,939 (75%) and 765,021 (25%) were admitted to hospitals with and without ICUs, respectively. Transfer between IMCUs and ICUs occurred for 10.5% (n = 320,938/3,061,960) of patients, with a large variability between hospitals. After adjusting for potential confounders, patients admitted to IMCUs in hospitals without ICUs had significantly higher in-hospital mortality than those in hospitals with ICUs (adjusted odds ratio: 1.15; 95% confidence interval: 1.10-1.20; p < 0.001).
conclusionsAdmission in IMCUs in hospitals without ICUs increased, but was associated with higher in-hospital mortality. These findings suggest that IMCUs should be placed in hospitals with ICUs.
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