Critical Care and Shock

In-hospital Mortality among Unplanned Admissions to a Medical Intensive Care Unit

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Objective: Despite advances in medicine, adverse clinical events, especially cardio-respiratory arrests, still occur in hospitalized patients. Unplanned Intensive Care Unit (ICU) admissions are frequently a result of this failure to recognize or appropriately treat the ‘pre-arrest’ period, when signs of physiologic deterioration are often evident. Although survival rates to hospital discharge for cardiac arrests are universally poor, the patterns of clinical deterioration and outcome of unplanned medical ICU admissions is not well studied. We aim to evaluate whether unplanned medical ICU admissions are associated with higher inhospital mortality.

Design: Prospective observational, 3-month data collection and analysis of case records and charts. In particular, intubation rates and reasons for unplanned admissions were analyzed.

Setting: 18-bed medical Intensive Care Unit in Changi General Hospital, a regional 790-bed hospital in Singapore.

Patients and participants: All medical and cardiac admissions to the Medical ICU from the general wards from October 2007 to January 2008. Direct admissions from the emergency department were excluded.

Measurements and results: A total of 423 admissions of which 37 (8.7%) were unplanned and 386 (91.3%) were planned. Data was analyzed using SPSS 12.0.1, and Pearson Chi-square for comparison. P value <0.05 considered to be statistically significant. There was a statistically significant difference in hospital mortality between planned (54 deaths, 14%) and unplanned admissions (25 deaths, 67.6%), (p <0.001). All but 1 patient in the unplanned group required intubation. Desaturation was the commonest reason for unplanned admissions, followed closely by sudden cardiorespiratory collapse and hypotension.

Conclusions: The high mortality rate among unplanned medical ICU admissions is a cause for concern. Implementing a system of early critical illness detection and specialist intervention may help reduce such mortality as well as provide more definitive planned palliative decisions.

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