Acute Crit Care.  2021 Nov;36(4):351-360. 10.4266/acc.2021.00283.

Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission

• Chang Y
• Kim KR
• Huh JW
• Hong SB
• Koh Y
• Lim CM

• KMID: 2524318
• DOI: http://doi.org/10.4266/acc.2021.00283

Abstract

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 were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, 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.

Keyword

critical care outcomes; critical illness; intensive care units; medical futility; patient admission; perception

Figure

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  Figure 1. Outcomes of patients according to the perception of intensivists on the appropriateness of intensive care unit (ICU) admission. Among the patients who were perceived as having non-beneficial admission by intensivists or for whom it was difficult for the intensivists to decide whether their ICU admission was beneficial (indeterminate) on ICU day 1, more than half died in the ICU, while most of them died after 6 months.

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