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Association between strained capacity and mortality among patients admitted to intensive care: A path-analysis modeling strategy.

Abstract：

PURPOSE:To evaluate the associations between strained ICU capacity and patient outcomes. METHODS:Multi-center population-based cohort study of nine integrated ICUs in Alberta, Canada. Path-analysis modeling was adopted to investigate direct and indirect associations between strain (available beds ≤1; occupancy ≥95%) and outcomes. Mixed-effects multivariate regression was used to measure the association between strain and acuity (APACHE II score), and both acuity and strain measures on ICU mortality and length of stay. RESULTS:12,265 admissions comprise the study cohort. Available beds ≤1 and occupancy ≥95% occurred for 22.3% and 17.0% of admissions. Lower bed availability was associated with higher APACHE II score (p<0.0001). The direct effect of ≤1 available beds at ICU admission on ICU mortality was 11.6% (OR 1.116; 95% CI, 0.995-1.252). Integrating direct and indirect effects resulted in a 16.5% increased risk of ICU mortality (OR 1.165; 95% CI, 1.036-1.310), which exceeded the direct effect by 4.9%. Findings were similar with strain defined as occupancy ≥95%. Strain was associated with shorter ICU stay, primarily mediated by greater acuity. CONCLUSIONS:Strained capacity was associated with increased ICU mortality, partly mediated through greater illness acuity. Future work should consider both the direct and indirect relationships of strain on outcomes.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Bagshaw SM,Wang X,Zygun DA,Zuege D,Dodek P,Garland A,Scales DC,Berthiaume L,Faris P,Chen G,Opgenorth D,Stelfox HT

doi

10.1016/j.jcrc.2017.08.032

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

81-87

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(17)30853-5

journal_volume

43

pub_type

杂志文章,多中心研究

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