Conditional survival with increasing duration of ICU admission: an observational study of three intensive care databases.
Author(s)
Marshall, Dominic C
Hatch, Robert A
Gerry, Stephen
Young, J Duncan
Watkinson, Peter
Type
Journal Article
Abstract
OBJECTIVES: Prolonged admissions to an ICU are associated with high resource utilization and personal cost to the patient. Previous reports suggest increasing length of stay may be associated with poor outcomes. Conditional survival represents the probability of future survival after a defined period of treatment on an ICU providing a description of how prognosis evolves over time. Our objective was to describe conditional survival as length of ICU stay increased. DESIGN: Retrospective observational cohort study of three large intensive care databases. SETTING: Three intensive care databases, two in the United States (Medical Information Mart for Intensive Care III and electronic ICU) and one in United Kingdom (Post Intensive Care Risk-Adjusted Alerting and Monitoring). PATIENTS: Index admissions to intensive care for patients 18 years or older. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 11,648, 38,532, and 165,125 index admissions were analyzed from Post Intensive Care Risk-Adjusted Alerting and Monitoring, Medical Information Mart for Intensive Care III and electronic ICU databases respectively. In all three cohorts, conditional survival declined over the first 5-10 days after ICU admission and changed little thereafter. In patients greater than or equal to 75 years old conditional survival continued to decline with increasing length of stay. CONCLUSIONS: After an initial period of 5-10 days, probability of future survival does not appear to decrease with increasing length of stay in unselected patients admitted to ICUs in United Kingdom and United States [corrected]. These findings were consistent between the three populations and suggest that a prolonged admission to an ICU is not a reason for a pessimism in younger patients but may indicate a poor prognosis in the older population.
Date Issued
2020-01-01
Date Acceptance
2020-01-01
Citation
Critical Care Medicine, 2020, 48 (1), pp.91-97
ISSN
0090-3493
Publisher
Lippincott, Williams & Wilkins
Start Page
91
End Page
97
Journal / Book Title
Critical Care Medicine
Volume
48
Issue
1
Copyright Statement
©2019 The Author(s). Published by Wolters Kluwer Health, Inc.
on behalf of the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. This is an open access article distributed under the Creative
Commons Attribution License 4.0 (CCBY), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
work is properly cited.
on behalf of the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. This is an open access article distributed under the Creative
Commons Attribution License 4.0 (CCBY), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
work is properly cited.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31725438
Subjects
Emergency & Critical Care Medicine
1103 Clinical Sciences
1110 Nursing
1117 Public Health and Health Services
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2020-01-01