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Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission
Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2021;36(4):351-360.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00283
  • 5,109 View
  • 138 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

Citations

Citations to this article as recorded by  
  • Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
    Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
    Journal of Critical Care.2024; 79: 154468.     CrossRef
  • Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
    Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
    Journal of Palliative Care.2023; 38(2): 126.     CrossRef
  • Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
    Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
    Internal and Emergency Medicine.2023; 18(4): 1191.     CrossRef
  • Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
    SeungYong Park
    Acute and Critical Care.2021; 36(4): 388.     CrossRef
Ethics
Characteristics and Outcomes of Potentially Inappropriate Admissions to the Intensive Care Unit
Sooim Sin, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2019;34(1):46-52.   Published online February 28, 2019
DOI: https://doi.org/10.4266/acc.2018.00388
  • 6,478 View
  • 145 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Background
Admission of patients perceived as potentially inappropriate for intensive care is a very sensitive and controversial issue. We aimed to evaluate the use of medical resources in the intensive care unit (ICU) and outcomes of patients according to a physician’s judgment of appropriateness. Methods: ICU physicians classified patients who were admitted to the medical ICU of a tertiary hospital as appropriate or inappropriate for intensive care within 24 hours of admission. Patient outcomes including mortality were analyzed according to appropriateness. Additionally, the usage and duration of mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) were analyzed according to appropriateness. Results: In total, 105 patients (male, 55.4%; mean age, 62 years) were included. Twelve (11.4%) patients were considered inappropriate for intensive care based on guidance published by the Society of Critical Care Medicine through a questionnaire survey of physicians. There was no significant difference between patients considered inappropriate or appropriate for ICU admission regarding the use and duration of MV, RRT, and ECMO. In contrast, the ICU, in-hospital, 28-day, 90-day, and total mortality rates were significantly higher among patients with inappropriate admission than among patients with appropriate admission (ICU mortality: 50.0% vs. 25.8%, P=0.008; in-hospital mortality: 58.3% vs. 43.0%, P=0.028; 28-day mortality: 58.3% vs. 33.3%, P=0.019; 90-day mortality: 66.7% vs. 44.1%, P=0.023). Conclusions: Despite higher mortality, the amount of medical resources used for patients considered potentially inappropriate for intensive care did not differ from the resources used for patients considered suitable for ICU care.

Citations

Citations to this article as recorded by  
  • Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
    Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
    Journal of Critical Care.2024; 79: 154468.     CrossRef
  • Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
    Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
    Internal and Emergency Medicine.2023; 18(4): 1191.     CrossRef
  • Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study
    Yanchen Liu, Yingchun Chen, Xueyan Cheng, Yan Zhang
    International Journal of Environmental Research and Public Health.2020; 17(16): 5963.     CrossRef

ACC : Acute and Critical Care