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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature125355
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Jakob Lundager Forberg
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Prospective Studies
Regression Analysis
Triage - methods - statistics & numerical data
Vital Signs
Young Adult
Abstract
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
Notes
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Cites: CJEM. 2008 Mar;10(2):151-7318371253
Cites: Rev Esp Salud Publica. 2008 May-Jun;82(3):251-918711640
Cites: Scand J Trauma Resusc Emerg Med. 2012;20:2922490233
Cites: Emerg Med J. 2010 Feb;27(2):86-9220156855
Cites: Resuscitation. 2010 Aug;81(8):932-720637974
Cites: J Emerg Med. 2011 Jun;40(6):623-818930373
Cites: Scand J Trauma Resusc Emerg Med. 2011;19:4221718476
Cites: Ugeskr Laeger. 2011 Oct 3;173(40):2490-321975184
Cites: J Emerg Med. 2010 Jan;38(1):70-918514465
PubMed ID
22490208 View in PubMed
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Acceptable long-term outcome in elderly intensive care unit patients.

https://arctichealth.org/en/permalink/ahliterature133259
Source
Dan Med Bull. 2011 Jul;58(7):A4297
Publication Type
Article
Date
Jul-2011
Author
Morten A Schrøder
Jesper Brøndum Poulsen
Anders Perner
Author Affiliation
Intensive Care Unit, 4131, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark. mortenschroder@gmail.com
Source
Dan Med Bull. 2011 Jul;58(7):A4297
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Confidence Intervals
Denmark
Female
Hospital Mortality - trends
Humans
Intensive Care Units - statistics & numerical data
Male
Mental health
Middle Aged
Outcome Assessment (Health Care)
Prospective Studies
Quality of Life
Questionnaires
Registries
Statistics, nonparametric
Survivors
Time Factors
Treatment Outcome
Young Adult
Abstract
The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.
The outcome status for 91 elderly (=75 years) and 659 nonelderly (18-74 years) ICU patients treated in the course of a one year period was obtained. A total of 36 of 37 eligible elderly survivors were interviewed about their health related quality of life (HRQOL), social services and their wish for intensive care.
The mortality (54% at follow-up and 64% after one year) was higher in the elderly ICU patients than in non-elderly ICU patients (33% and 37%, respectively, p
PubMed ID
21722543 View in PubMed
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Acute kidney injury in intensive care units according to RIFLE classification: a population-based study.

https://arctichealth.org/en/permalink/ahliterature120468
Source
Acta Anaesthesiol Scand. 2012 Nov;56(10):1291-7
Publication Type
Article
Date
Nov-2012
Author
M I Sigurdsson
I O Vesteinsdottir
K. Sigvaldason
S. Helgadottir
O S Indridason
G H Sigurdsson
Author Affiliation
Department of Anaesthesia & Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland.
Source
Acta Anaesthesiol Scand. 2012 Nov;56(10):1291-7
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - classification - epidemiology
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Confidence Intervals
Creatinine - blood
Female
Humans
Iceland - epidemiology
Intensive Care Units - statistics & numerical data
Kaplan-Meier Estimate
Kidney Failure, Chronic - epidemiology - mortality
Male
Middle Aged
Population
Renal Replacement Therapy - statistics & numerical data
Retrospective Studies
Risk factors
Survival
Young Adult
Abstract
Recent studies of the incidence of acute kidney injury (AKI) are largely based on estimated baseline serum creatinine values. The aim of this study was to more accurately determine the incidence of AKI using the RIFLE criteria for intensive care unit (ICU) patients of a whole population.
All adult patients admitted to the ICUs of Landspitali - The National University Hospital of Iceland in 2007 (n = 1026) were studied with meticulous search for baseline creatinine. The underlying risk factors and contributing causes for AKI were defined, and survival and ratio of end-stage renal failure evaluated.
A measured baseline creatinine value was found for all but two patients with AKI. The incidence of AKI according to RIFLE criteria was 21.7% [95% confidence interval (CI): 19.0-24.1%], with 7.1% (95 CI: 5.6-8.9%), 6.8% (95 CI: 5.3-8.5%) and 7.8% (95 CI: 6.2-9.6%) in the risk, injury and failure subgroups. Using estimated baseline creatinine overestimated the incidence of AKI by 3.5%. The sensitivity and specificity of the RIFLE criteria using estimated baseline creatinine were 76% and 95%. Renal replacement therapy was required for 17% of the AKI patients. One year survival of AKI patients was 51%, but only 2.5% of patients surviving 90 days required chronic renal replacement therapy.
The incidence of AKI in the ICU was lower than previously published, perhaps due to overestimation of AKI using estimated baseline creatinine or bias from tertiary referrals. AKI patients have high mortality, but the survivors have a low incidence of end-stage renal failure.
PubMed ID
22999042 View in PubMed
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Acute kidney injury in patients with severe sepsis in Finnish Intensive Care Units.

https://arctichealth.org/en/permalink/ahliterature113544
Source
Acta Anaesthesiol Scand. 2013 Aug;57(7):863-72
Publication Type
Article
Date
Aug-2013
Author
M. Poukkanen
S T Vaara
V. Pettilä
K-M Kaukonen
A-M Korhonen
S. Hovilehto
O. Inkinen
R. Laru-Sompa
T. Kaminski
M. Reinikainen
V. Lund
S. Karlsson
Author Affiliation
Department of Anaesthesia and Intensive Care Medicine, Lapland Central Hospital, Rovaniemi, Finland.
Source
Acta Anaesthesiol Scand. 2013 Aug;57(7):863-72
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - epidemiology - etiology - therapy
Aged
Colloids - therapeutic use
Comorbidity
Creatinine - blood
Female
Finland - epidemiology
Hospital Mortality
Humans
Incidence
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Mass Screening
Middle Aged
Multiple Organ Failure - epidemiology
Prospective Studies
Renal Replacement Therapy - utilization
Sepsis - complications - epidemiology - microbiology
Treatment Outcome
Abstract
Severe sepsis is one of the leading causes of acute kidney injury (AKI). Patients with sepsis-associated AKI demonstrate high-hospital mortality. We evaluated the incidence of severe sepsis-associated AKI and its association with outcome in intensive care units (ICUs) in Finland.
This was a predetermined sub-study of the prospective, observational, multicentre FINNAKI study conducted in 17 ICUs during 1 September 2011 and 1 February 2012. All emergency ICU admissions and elective admissions exceeding 24 hours in the ICU were screened for presence of severe sepsis and AKI up to 5 days in ICU. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and severe sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria.
Of the 2901 included patients, severe sepsis was diagnosed in 918 (31.6%, 95% confidence interval [CI] 29.9-33.4%) patients. Of these 918 patients, 488 (53.2% [95% CI 49.9-56.5%]) had AKI. The 90-day mortality rate was 38.1% (95% CI 33.7-42.5%) for severe sepsis patients with AKI and 24.7% (95% CI 20.5-28.8%) for those without AKI. After adjusting for covariates, KDIGO stage 3 AKI was associated with an increased risk for 90-day mortality with an adjusted odds ratio (OR) of 1.94 (95% CI 1.28-2.94), but stages 1 and 2 were not.
More than half of the patients with severe sepsis had AKI according to the KDIGO classification, and AKI stage 3 was independently associated with 90-day mortality.
PubMed ID
23713703 View in PubMed
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Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores.

https://arctichealth.org/en/permalink/ahliterature168850
Source
J Crit Care. 2006 Jun;21(2):142-50
Publication Type
Article
Date
Jun-2006
Author
Monica Norena
Hubert Wong
Willie D Thompson
Sean P Keenan
Peter M Dodek
Author Affiliation
Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada V6Z 1Y6.
Source
J Crit Care. 2006 Jun;21(2):142-50
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
British Columbia
Comorbidity
Coronary Care Units - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Regression Analysis
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Treatment Outcome
Abstract
Comparison of outcomes among intensive care units (ICUs) requires adjustment for patient variables. Severity of illness scores are associated with hospital mortality, but administrative databases rarely include the elements of these scores. However, these databases include the elements of comorbidity scores. The purpose of this study was to compare the value of these scores as adjustment variables in statistical models of hospital mortality and hospital and ICU length of stay after adjustment for other covariates.
We used multivariable regression to study 1808 patients admitted to a 13-bed medical-surgical ICU in a 400-bed tertiary hospital between December 1998 and August 2003.
For all patients, after adjusting for age, sex, major clinical category, source of admission, and socioeconomic determinants of health, we found that Acute Physiology and Chronic Health Evaluation (APACHE) II and comorbidity scores were significantly associated with hospital mortality and that comorbidity but not APACHE II was significantly associated with hospital length of stay. Separate analysis of hospital survivors and nonsurvivors showed that both APACHE II and comorbidity scores were significantly associated with hospital length of stay and APACHE II score was associated with ICU length of stay.
The value of APACHE II and comorbidity scores as adjustment variables depends on the outcome and population of interest.
PubMed ID
16769457 View in PubMed
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Adverse events are common on the intensive care unit: results from a structured record review.

https://arctichealth.org/en/permalink/ahliterature124542
Source
Acta Anaesthesiol Scand. 2012 Sep;56(8):959-65
Publication Type
Article
Date
Sep-2012
Author
L. Nilsson
A. Pihl
M. Tågsjö
E. Ericsson
Author Affiliation
Division of Drug Research, Anesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Sweden. lena.nilsson@lio.se
Source
Acta Anaesthesiol Scand. 2012 Sep;56(8):959-65
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
APACHE
Adolescent
Adult
Adverse Drug Reaction Reporting Systems
Aged
Aged, 80 and over
Child
Child, Preschool
Drug-Related Side Effects and Adverse Reactions - epidemiology - prevention & control
Female
Harm Reduction
Hospital Mortality
Humans
Infant
Infant, Newborn
Intensive Care Units - statistics & numerical data
Longevity
Male
Medical Errors
Medical Records
Middle Aged
Retrospective Studies
Sweden
Young Adult
Abstract
Intensive care is advanced and highly technical, and it is essential that, despite this, patient care remains safe and of high quality. Adverse events (AEs) are supposed to be reported to internal quality control systems by health-care providers, but many are never reported. Patients on the intensive care unit (ICU) are at special risk for AEs. Our aim was to identify the incidence and characteristics of AEs in patients who died on the ICU during a 2-year period.
A structured record review according to the Global Trigger Tool (GTT) was used to review charts from patients cared for at the ICU of a middle-sized Swedish hospital during 2007 and 2008 and who died during or immediately after ICU care. All identified AEs were scored according to severity and preventability.
We reviewed 128 records, and 41 different AEs were identified in 25 patients (19.5%). Health care-associated infections, hypoglycaemia, pressure sores and procedural complications were the most common harmful events. Twenty two (54%) of the AEs were classified as being avoidable. Two of the 41 AEs were reported as complications according to the Swedish Intensive Care Registry, and one AE had been reported in the internal AE-reporting system.
Almost one fifth of the patients who died on the ICU were subjected to harmful events. GTT has the advantage of identifying more patient injuries caused by AEs than the traditional AE-reporting systems used on many ICUs.
PubMed ID
22571769 View in PubMed
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Adverse outcomes associated with delayed intensive care consultation in medical and surgical inpatients.

https://arctichealth.org/en/permalink/ahliterature123440
Source
J Crit Care. 2012 Dec;27(6):688-93
Publication Type
Article
Date
Dec-2012
Author
Louay Mardini
Jed Lipes
Dev Jayaraman
Author Affiliation
Montreal General Hospital, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada.
Source
J Crit Care. 2012 Dec;27(6):688-93
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Female
Humans
Intensive Care Units - statistics & numerical data
Length of Stay
Male
Middle Aged
Mortality
Patient Transfer - statistics & numerical data
Referral and Consultation - statistics & numerical data
Retrospective Studies
Socioeconomic Factors
Tertiary Care Centers - statistics & numerical data
Time Factors
Treatment Outcome
Abstract
The impact of delay in obtaining an intensive care unit (ICU) consult from inpatient wards is unclear. The goal of this study was to examine the effect of time to ICU consult from medical and surgical wards on mortality and length of stay (LOS).
This was a retrospective study of 241 adult medical and surgical inpatients admitted at 2 tertiary care ICUs in Canada between 2007 and 2009. Neither institution has medical emergency teams (METs). Patient demographics, time when the patient would have fulfilled MET calling criteria (MET time), time of ICU consult, and ICU admission were analyzed. The main outcome variables were 30-day mortality and ICU LOS.
Multivariate analysis demonstrated an increase in mortality (odds ratio, 1.8; 95% confidence interval, 1.1-2.9; P = .01) with increased duration from MET time to ICU consult for medical patients. There was no effect of this period on ICU LOS in medical patients. In contrast, in surgical patients, the MET time to ICU consult duration was associated with an increased ICU LOS (coefficient, 2.1 for delay; 95% confidence interval, 0.26-3.8; P = .02) but had no effect on mortality.
Increased duration to ICU consult from MET time is associated with adverse outcomes. These adverse outcomes are different between medical and surgical patients.
PubMed ID
22699035 View in PubMed
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Age of red blood cells and outcome in acute kidney injury.

https://arctichealth.org/en/permalink/ahliterature263080
Source
Crit Care. 2013;17(5):R222
Publication Type
Article
Date
2013
Author
Kirsi-Maija Kaukonen
Suvi T Vaara
Ville Pettilä
Rinaldo Bellomo
Jarno Tuimala
David J Cooper
Tom Krusius
Anne Kuitunen
Matti Reinikainen
Juha Koskenkari
Ari Uusaro
Source
Crit Care. 2013;17(5):R222
Date
2013
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - blood - mortality - therapy
Aged
Critical Illness
Erythrocyte Aging
Erythrocyte Transfusion - mortality
Female
Finland - epidemiology
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Prospective Studies
Risk assessment
Risk factors
Abstract
Transfusion of red blood cells (RBCs) and, in particular, older RBCs has been associated with increased short-term mortality in critically ill patients. We evaluated the association between age of transfused RBCs and acute kidney injury (AKI), hospital, and 90-day mortality in critically ill patients.
We conducted a prospective, observational, predefined sub-study within the FINNish Acute Kidney Injury (FINNAKI) study. This study included all elective ICU admissions with expected ICU stay of more than 24 hours and all emergency admissions from September to November 2011. To study the age of RBCs, we classified transfused patients into quartiles according to the age of oldest transfused RBC unit in the ICU. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria.
Out of 1798 patients, 652 received at least one RBC unit. The median [interquartile range] age of the oldest RBC unit transfused was 12 [11-13] days in the freshest quartile and 21 [17-27] days in the quartiles 2 to 4. On logistic regression, RBC age was not associated with the development of KDIGO stage 3 AKI. Patients in the quartile of freshest RBCs had lower crude hospital and 90-day mortality rates compared to those in the quartiles of older blood. After adjustments, older RBC age was associated with significantly increased risk for hospital mortality. Age, Simplified Acute Physiology Score II (SAPS II)-score without age points, maximum Sequental Organ Failure Assessment (SOFA) score and the total number of transfused RBC units were independently associated with 90-day mortality.
The age of transfused RBC units was independently associated with hospital mortality but not with 90-day mortality or KDIGO stage 3 AKI. The number of transfused RBC units was an independent risk factor for 90-day mortality.
Notes
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PubMed ID
24093554 View in PubMed
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Age, risk, and life expectancy in Norwegian intensive care: a registry-based population modelling study.

https://arctichealth.org/en/permalink/ahliterature269801
Source
PLoS One. 2015;10(5):e0125907
Publication Type
Article
Date
2015
Author
Frode Lindemark
Øystein A Haaland
Reidar Kvåle
Hans Flaatten
Kjell A Johansson
Source
PLoS One. 2015;10(5):e0125907
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Female
Humans
Intensive Care Units - statistics & numerical data
Life expectancy
Male
Middle Aged
Models, Theoretical
Mortality
Norway - epidemiology
Patient Admission
Patient Selection
Registries - statistics & numerical data
Risk factors
Survival Analysis
Time Factors
Young Adult
Abstract
Knowledge about the expected life years gained from intensive care unit (ICU) admission could inform priority-setting decisions across groups of ICU patients and across medical specialties. The aim of this study was to estimate expected remaining lifetime for patients admitted to ICUs during 2008-2010 and to estimate the gain in life years from ICU admission.
This is a descriptive, population modelling study of 30,712 adult mixed ICU admissions from the Norwegian Intensive Care Registry. The expected remaining lifetime for each patient was estimated using a decision-analytical model. Transition probabilities were based on registered Simplified Acute Physiology Score (SAPS) II, and standard and adjusted Norwegian life-tables.
The hospital mortality was 19.4% (n = 5,958 deaths). 24% of the patients were estimated to die within the first year after ICU admission in our model. Under an intermediate (base case), optimistic (O), and pessimistic (P) scenario with respect to long-term mortality, the average expected remaining lifetime was 19.4, 19.9, and 12.7 years. The majority of patients had a life expectancy of more than five years (84.8% in the base case, 89.4% in scenario O, and 55.6% in scenario P), and few had a life expectancy of less than one year (0.7%, 0.1%, and 12.7%). The incremental gain from ICU admission compared to counterfactual general ward care was estimated to be 0.04 (scenario P, age 85+) to 1.14 (scenario O, age
Notes
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PubMed ID
26011281 View in PubMed
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All Danish first-time COPD hospitalisations 2002-2008: incidence, outcome, patients, and care.

https://arctichealth.org/en/permalink/ahliterature129368
Source
Respir Med. 2012 Apr;106(4):549-56
Publication Type
Article
Date
Apr-2012
Author
Jesper Lykkegaard
Jens Søndergaard
Jakob Kragstrup
Jesper Rømhild Davidsen
Thomas Knudsen
Morten Andersen
Author Affiliation
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 1, DK-5000 Odense C, Denmark. jlykkegaard@health.sdu.dk
Source
Respir Med. 2012 Apr;106(4):549-56
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data - trends
Denmark - epidemiology
Female
Hospital Mortality - trends
Hospitalization - statistics & numerical data - trends
Humans
Incidence
Intensive Care Units - statistics & numerical data - trends
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive - epidemiology
Sex Distribution
Treatment Outcome
Abstract
This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients.
Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed.
During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased.
Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study.
PubMed ID
22115929 View in PubMed
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