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Trends in Severity of Illness on ICU Admission and Mortality among the Elderly

BACKGROUND: There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital befo...

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Autores principales: Fuchs, Lior, Novack, Victor, McLennan, Stuart, Celi, Leo Anthony, Baumfeld, Yael, Park, Shinhyuk, Howell, Michael D., Talmor, Daniel S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974713/
https://www.ncbi.nlm.nih.gov/pubmed/24699251
http://dx.doi.org/10.1371/journal.pone.0093234
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author Fuchs, Lior
Novack, Victor
McLennan, Stuart
Celi, Leo Anthony
Baumfeld, Yael
Park, Shinhyuk
Howell, Michael D.
Talmor, Daniel S.
author_facet Fuchs, Lior
Novack, Victor
McLennan, Stuart
Celi, Leo Anthony
Baumfeld, Yael
Park, Shinhyuk
Howell, Michael D.
Talmor, Daniel S.
author_sort Fuchs, Lior
collection PubMed
description BACKGROUND: There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU. METHODS: We conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission. RESULTS: Between the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008. CONCLUSION: In a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective.
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spelling pubmed-39747132014-04-08 Trends in Severity of Illness on ICU Admission and Mortality among the Elderly Fuchs, Lior Novack, Victor McLennan, Stuart Celi, Leo Anthony Baumfeld, Yael Park, Shinhyuk Howell, Michael D. Talmor, Daniel S. PLoS One Research Article BACKGROUND: There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU. METHODS: We conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission. RESULTS: Between the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008. CONCLUSION: In a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective. Public Library of Science 2014-04-03 /pmc/articles/PMC3974713/ /pubmed/24699251 http://dx.doi.org/10.1371/journal.pone.0093234 Text en © 2014 Fuchs et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Fuchs, Lior
Novack, Victor
McLennan, Stuart
Celi, Leo Anthony
Baumfeld, Yael
Park, Shinhyuk
Howell, Michael D.
Talmor, Daniel S.
Trends in Severity of Illness on ICU Admission and Mortality among the Elderly
title Trends in Severity of Illness on ICU Admission and Mortality among the Elderly
title_full Trends in Severity of Illness on ICU Admission and Mortality among the Elderly
title_fullStr Trends in Severity of Illness on ICU Admission and Mortality among the Elderly
title_full_unstemmed Trends in Severity of Illness on ICU Admission and Mortality among the Elderly
title_short Trends in Severity of Illness on ICU Admission and Mortality among the Elderly
title_sort trends in severity of illness on icu admission and mortality among the elderly
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974713/
https://www.ncbi.nlm.nih.gov/pubmed/24699251
http://dx.doi.org/10.1371/journal.pone.0093234
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