Acute Crit Care.  2019 Feb;34(1):46-52. 10.4266/acc.2018.00388.

Characteristics and Outcomes of Potentially Inappropriate Admissions to the Intensive Care Unit

• Sin S
• Lee SM
• Lee J

• KMID: 2449379
• DOI: http://doi.org/10.4266/acc.2018.00388

Abstract

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.

Keyword

critical care; health resources; intensive care units; medical futility; mortality

MeSH Terms

Critical Care*
Extracorporeal Membrane Oxygenation
Health Resources
Hospital Mortality
Humans
Intensive Care Units*
Judgment
Medical Futility
Mortality
Renal Replacement Therapy
Respiration, Artificial
Tertiary Care Centers

Figure

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  Figure 1. Flow diagram of study population. MICU: medical intensive care unit.

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  Figure 2. Survival analysis of patients in appropriate and potentially inappropriate treatment groups. (A) ICU mortality, (B) hospital mortality, (C) 28-day mortality, (D) 90-day mortality according to appropriateness of patients. ICU: intensive care unit.

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