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Impact of triage-to-admission time on patient outcome in European intensive care units: A prospective, multi-national study

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Stohl, Sheldon ; Sprung, Charles L ; Lippert, Anne ; Pirracchio, Romain ; Artigas, Antonio ; Iapichino, Gaetano ; Harris, Steve ; Pezzi, Angelo ; Schlesinger, Malka. / Impact of triage-to-admission time on patient outcome in European intensive care units : A prospective, multi-national study. In: Journal of Critical Care. 2019 ; Vol. 53. pp. 11-17.

Bibtex

@article{b7bd4955fcdc4fb3973355be661d4e90,
title = "Impact of triage-to-admission time on patient outcome in European intensive care units: A prospective, multi-national study",
abstract = "PURPOSE: Ubiquitous bed shortages lead to delays in intensive care unit (ICU) admissions worldwide. Assessing the impact of delayed admission must account for illness severity. This study examined both the relationship between triage-to-admission time and 28-day mortality and the impact of controlling for Simplified Acute Physiology Score (SAPS) II scores on that relationship.METHODS: Prospective cross-sectional analysis of referrals to eleven ICUs in seven European countries between 2003 and 2005. Outcomes among patients admitted within versus after 4 h were compared using a Chi-square test. Triage-to-admission time was also analyzed as a continuous variable; outcomes were assessed using a non-parametric Kruskal-Wallis test.RESULTS: Among 3175 patients analyzed, triage-to-admission time was 2.1 ± 3.9 h. Patients admitted within 4 h had higher SAPS II scores (33.6 versus 30.6, Pearson correlation coefficient -0.07, p < 0.0001). 28-day mortality was surprisingly higher among patients admitted earlier (29.6 vs 25.2{\%}, OR 1.25, 95{\%} CI 0.99-1.58, p = 0.06). Even after adjusting for SAPS II scores, delayed admission was not associated with higher mortality (OR 1.08, CI 0.83-1.41, p = 0.58).CONCLUSIONS: Even after accounting for quantifiable parameters of illness severity, delayed admission did not negatively impact outcome. Triage practices likely influence outcomes. Severity scores may not fully reflect illness acuity or trajectory.",
author = "Sheldon Stohl and Sprung, {Charles L} and Anne Lippert and Romain Pirracchio and Antonio Artigas and Gaetano Iapichino and Steve Harris and Angelo Pezzi and Malka Schlesinger",
note = "Copyright {\circledC} 2019 Elsevier Inc. All rights reserved.",
year = "2019",
month = "5",
day = "29",
doi = "10.1016/j.jcrc.2019.05.013",
language = "English",
volume = "53",
pages = "11--17",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "W.B./Saunders Co",

}

RIS

TY - JOUR

T1 - Impact of triage-to-admission time on patient outcome in European intensive care units

T2 - A prospective, multi-national study

AU - Stohl, Sheldon

AU - Sprung, Charles L

AU - Lippert, Anne

AU - Pirracchio, Romain

AU - Artigas, Antonio

AU - Iapichino, Gaetano

AU - Harris, Steve

AU - Pezzi, Angelo

AU - Schlesinger, Malka

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/5/29

Y1 - 2019/5/29

N2 - PURPOSE: Ubiquitous bed shortages lead to delays in intensive care unit (ICU) admissions worldwide. Assessing the impact of delayed admission must account for illness severity. This study examined both the relationship between triage-to-admission time and 28-day mortality and the impact of controlling for Simplified Acute Physiology Score (SAPS) II scores on that relationship.METHODS: Prospective cross-sectional analysis of referrals to eleven ICUs in seven European countries between 2003 and 2005. Outcomes among patients admitted within versus after 4 h were compared using a Chi-square test. Triage-to-admission time was also analyzed as a continuous variable; outcomes were assessed using a non-parametric Kruskal-Wallis test.RESULTS: Among 3175 patients analyzed, triage-to-admission time was 2.1 ± 3.9 h. Patients admitted within 4 h had higher SAPS II scores (33.6 versus 30.6, Pearson correlation coefficient -0.07, p < 0.0001). 28-day mortality was surprisingly higher among patients admitted earlier (29.6 vs 25.2%, OR 1.25, 95% CI 0.99-1.58, p = 0.06). Even after adjusting for SAPS II scores, delayed admission was not associated with higher mortality (OR 1.08, CI 0.83-1.41, p = 0.58).CONCLUSIONS: Even after accounting for quantifiable parameters of illness severity, delayed admission did not negatively impact outcome. Triage practices likely influence outcomes. Severity scores may not fully reflect illness acuity or trajectory.

AB - PURPOSE: Ubiquitous bed shortages lead to delays in intensive care unit (ICU) admissions worldwide. Assessing the impact of delayed admission must account for illness severity. This study examined both the relationship between triage-to-admission time and 28-day mortality and the impact of controlling for Simplified Acute Physiology Score (SAPS) II scores on that relationship.METHODS: Prospective cross-sectional analysis of referrals to eleven ICUs in seven European countries between 2003 and 2005. Outcomes among patients admitted within versus after 4 h were compared using a Chi-square test. Triage-to-admission time was also analyzed as a continuous variable; outcomes were assessed using a non-parametric Kruskal-Wallis test.RESULTS: Among 3175 patients analyzed, triage-to-admission time was 2.1 ± 3.9 h. Patients admitted within 4 h had higher SAPS II scores (33.6 versus 30.6, Pearson correlation coefficient -0.07, p < 0.0001). 28-day mortality was surprisingly higher among patients admitted earlier (29.6 vs 25.2%, OR 1.25, 95% CI 0.99-1.58, p = 0.06). Even after adjusting for SAPS II scores, delayed admission was not associated with higher mortality (OR 1.08, CI 0.83-1.41, p = 0.58).CONCLUSIONS: Even after accounting for quantifiable parameters of illness severity, delayed admission did not negatively impact outcome. Triage practices likely influence outcomes. Severity scores may not fully reflect illness acuity or trajectory.

U2 - 10.1016/j.jcrc.2019.05.013

DO - 10.1016/j.jcrc.2019.05.013

M3 - Journal article

VL - 53

SP - 11

EP - 17

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -

ID: 57450230