Evidence map›Paper›PMID 42825231›Full record

ArticleCritical care explorations2026

Characteristics and Outcomes of Patients Referred but Declined for ICU Admission in a Resource-Limited Setting in South Africa.

George L Anesi, Nqobile Ndadane, Jonathan Invernizzi, Saajid Ally Alladeen, Arisha Ramkillawan, Stella M Savarimuthu, Robert D Wise, Michelle T D Smith, Zane Farina

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

George L AnesiDivision of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.ORCID https://orcid.org/0000-0003-4585-0714
Nqobile NdadaneDepartment of Anaesthesia and Critical Care, Grey's Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Jonathan InvernizziDepartment of Anaesthesia and Critical Care, Harry Gwala Regional Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Saajid Ally AlladeenDepartment of Anaesthesia and Critical Care, Harry Gwala Regional Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Arisha RamkillawanDepartment of Anaesthesia and Critical Care, Grey's Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Stella M SavarimuthuDivision of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY.
Robert D WiseDepartment of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
Michelle T D SmithDepartment of Anaesthesia and Critical Care, Grey's Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Zane FarinaDepartment of Anaesthesia and Critical Care, Grey's Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.

Funding

Identifying patient subgroups and processes of care that cause outcome differences following ICU vs. ward triage among patients with acute respiratory failure and sepsisR01HL166269 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI George L Anesi, Scott D Halpern · 2023 to 2026
$2.9M
Hospital adaptation and resiliency for infected and uninfected patients during respiratory viral surge events: from seasonal influenza to COVID-19K23HL161353 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI George L Anesi · 2022 to 2026
$837k
NHLBI NIH HHS K23 HL161353NHLBI NIH HHS R01 HL166269
6 · The paper itself

Abstract

objectivesICU beds are a limited resource and assessing net benefit from ICU admission remains incompletely understood. We sought to examine characteristics and outcomes of patients referred but declined for ICU admission, stratified by clinician-perceived likelihood of ICU benefit.

designDescriptive, retrospective cohort study.

settingTwo public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2022 to June 2022. PATIENTS: Adult ICU-referred patients classified into four triage cohorts by clinician-assessed acuity and ICU triage status: ICU admissions; high-acuity capacity-declined ICU referrals; high-acuity prognosis-declined ICU referrals; and low-acuity prognosis-declined ICU referrals.

interventionsNone. MEASUREMENTS AND MAIN

resultsWe report descriptive statistics of ICU-referred patient characteristics stratified by triage cohorts and mortal status. Among 866 ICU referrals, 469 patients (54.2%) were admitted, and 397 patients (45.8%) were declined for ICU admission. ICU admissions had an observed all-cause 30-day hospital mortality of 27.7%. Among declined ICU referrals with nonmissing triage priority scores (

conclusionsIn one sampling in the South African public healthcare system, many patients are referred but declined for ICU admission due to perceptions of being both "too well" or "too sick" to benefit and due to bed capacity, with a proportion of such patients experiencing potential clinical deviations from triage-expected trajectories.

Indexed as

Intensive Care UnitsPatient AdmissionReferral and ConsultationAdultFemaleHospital MortalityHumansMaleMiddle AgedResource-Limited SettingsRetrospective StudiesSouth AfricaTriageglobal healthintensive care unitlow- and middle-income countriesresource-limited settingsscarce resource utilizationtriage

Identifiers

PMID42825231
PMCPMC13629843

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.