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KMID : 1144420210360040351
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Acute and Critical Care
2021 Volume.36 No. 4 p.351 ~ p.360
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Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission
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Chang You-Jin
Kim Kyoung-Ran
Huh Jin-Won
Hong Sang-Bum
Koh Youn-Suck
Lim Chae-Man
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Abstract
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Background: It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods: A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results: A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group on day 1 were 59%, 23%, and 59%, respectively; their 6-month mortality rates were 100%, 48%, and 82%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3; odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892?8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260?19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162?17.121; P=0.029).
Conclusions: The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.
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KEYWORD
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critical care outcomes, critical illness, intensive care units, medical futility, patient admission, perception
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