The Timing of Discharge from ICU and Subsequent Mortality: A Prospective Multi-center Study.
Am J Respir Crit Care Med. 2015 Mar 2;
Authors: Santamaria JD, Duke GJ, Pilcher DV, Cooper DJ, Moran J, Bellomo R, for the Discharge and Readmission Evaluation (DARE) study
Abstract
Importance: Previous studies suggested an association between after-hours ICU discharge and increased hospital mortality. Their retrospective design and lack of correction for patient factors present at the time of discharge, make this association problematic. Objective: To determine factors independently associated with mortality following ICU discharge Design: Prospective multicenter bi-national observational study Setting: Forty intensive care units in Australia and New Zealand Participants: Consecutive adult patients discharged alive from ICU between September 2009 and February 2010. Exposure: Discharge alive from ICU Main Outcomes and Measures: In hospital mortality Results: We studied 10,211 patients discharged alive from ICU. Median age was 63 years (IQR 49-74), 6224 (61%) were male, 5707 (56%) required mechanical ventilation, and their median APACHE-III risk of death was 9% (IQR 3%-25%). 8539 (83.6%) patients were discharged in-hours (0600-1800) and 1672 (16.4%) after-hours (1800-0600). Of these, 408 (4.8%) and 124 (7.4%) respectively subsequently died in hospital (P <0.001). After risk adjustment for markers of illness severity at time of ICU discharge including limitations of medical therapy (LOMT) orders, the time of discharge was no longer a significant predictor of mortality. The presence of a LOMT order was the strongest predictor of death (odds ratio 35.4; 95% CI, 27.5-45.6). Conclusion In this large prospective multi-center bi-national observational study, we found that patient status at ICU discharge, particularly the presence of LOMT orders, was the chief predictor of hospital survival. In contrast to previous studies, the timing of discharge did not have an independent association with mortality.
PMID: 25730675 [PubMed - as supplied by publisher]