Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study.
Crit Care. 2011 Jan 18;15(1):R28
Authors: Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, Bonametti AM
ABSTRACT: INTRODUCTION: When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients. METHODS: A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, APACHE II score, therapeutic intervention, and SOFA score. All patients were followed until hospital discharge. RESULTS: 401 patients were evaluated. 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% - 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio: 1.015; 95% CI 1.006 - 1.023; P = 0.001). CONCLUSIONS: There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes.
PMID: 21244671 [PubMed - as supplied by publisher]