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Survival of patients transferred to tertiary intensive care from rural community hospitals.

Surgenor SD, Corwin HL, Clerico T - Crit Care (2000)

Bottom Line: The two groups did not differ significantly in the characteristics measured.Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU.The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of Critical Care Medicine, Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. stephen.d.surgenor@hitchcock.ORG

ABSTRACT

Background: Accessibility to tertiary intensive care resources differs among hospitals within a rural region. Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population.

Methods: In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly from other hospitals and 178 transferred from the wards within a rural tertiary-care hospital.

Results: The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.

Conclusions: Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.

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Kaplan-Meier plot of in-hospital survival time adjusted for APACHE score on ICU day 1.
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Figure 1: Kaplan-Meier plot of in-hospital survival time adjusted for APACHE score on ICU day 1.

Mentions: In-hospital mortality was not significantly different between outside and internal transfers: 33% versus 30%, respectively (P = 0.58) (Table 2). The odds ratio for transferring from another hospital was 1.14 (95% confidence interval 0.72-1.83). There was no significant difference in the frequency of unanticipated deaths, 7.5% versus 9.5%, respectively (P = 0.51). In addition, standardized mortality ratios for both groups were within 95% confidence intervals, demonstrating no significant difference between observed mortality and predicted mortality based on APACHE II. The median length of stay (LOS) from time of admission to the ICU to either hospital discharge or death was not significantly different between outside and internal transfers (9 versus 11 days, respectively, P = 0.08). Median LOS in the ICU (3 versus 4 days, respectively, P = 0.74) was also comparable. Survival time analysis was completed using LOS from time of admission to the ICU to either discharge or in-hospital death. Seventy-five per cent of hospital discharges or deaths occurred within 19 days from admission to the ICU date. Survival time (Fig. 1) after adjustment for severity of illness was not significantly different for the interhospital transfer group as compared with internal ICU transfers (log rank test, P = 0.24).


Survival of patients transferred to tertiary intensive care from rural community hospitals.

Surgenor SD, Corwin HL, Clerico T - Crit Care (2000)

Kaplan-Meier plot of in-hospital survival time adjusted for APACHE score on ICU day 1.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC30715&req=5

Figure 1: Kaplan-Meier plot of in-hospital survival time adjusted for APACHE score on ICU day 1.
Mentions: In-hospital mortality was not significantly different between outside and internal transfers: 33% versus 30%, respectively (P = 0.58) (Table 2). The odds ratio for transferring from another hospital was 1.14 (95% confidence interval 0.72-1.83). There was no significant difference in the frequency of unanticipated deaths, 7.5% versus 9.5%, respectively (P = 0.51). In addition, standardized mortality ratios for both groups were within 95% confidence intervals, demonstrating no significant difference between observed mortality and predicted mortality based on APACHE II. The median length of stay (LOS) from time of admission to the ICU to either hospital discharge or death was not significantly different between outside and internal transfers (9 versus 11 days, respectively, P = 0.08). Median LOS in the ICU (3 versus 4 days, respectively, P = 0.74) was also comparable. Survival time analysis was completed using LOS from time of admission to the ICU to either discharge or in-hospital death. Seventy-five per cent of hospital discharges or deaths occurred within 19 days from admission to the ICU date. Survival time (Fig. 1) after adjustment for severity of illness was not significantly different for the interhospital transfer group as compared with internal ICU transfers (log rank test, P = 0.24).

Bottom Line: The two groups did not differ significantly in the characteristics measured.Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU.The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of Critical Care Medicine, Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. stephen.d.surgenor@hitchcock.ORG

ABSTRACT

Background: Accessibility to tertiary intensive care resources differs among hospitals within a rural region. Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population.

Methods: In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly from other hospitals and 178 transferred from the wards within a rural tertiary-care hospital.

Results: The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.

Conclusions: Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.

Show MeSH