Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis

Yang, Shuanying; Wang, Zheng; Liu, Zhida; Wang, Jinlai; Ma, Lijun

doi:10.1186/s13054-016-1569-x

Cited by 43 publications

(60 citation statements)

References 49 publications

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“…The inclusion of readmission as an outcome in the current study is important, because it may be a marker of deterioration after discharge. The previous review and meta-analysis by Yang et al included 14 observational cohort studies of 953,312 patients [1]. Their finding of increased mortality by 33% in out-of-hours discharge compared with in-hours discharge is compatible with the current meta-analysis.…”

supporting

confidence: 79%

“…The findings by Vollam et al extend results from a previous review and meta-analysis on time of discharge from ICU and mortality by including studies with and without adjustment for severity of illness and by including ICU readmission as an outcome [1]. The inclusion of readmission as an outcome in the current study is important, because it may be a marker of deterioration after discharge.…”

supporting

confidence: 72%

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mentioning

confidence: 99%

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Out-of-hours discharge from intensive care: certain about uncertainty

Christiansen

2018

Intensive Care Med

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Discharges out of hours comprise 15% of discharges from intensive care units (ICUs) to wards [1], and are usually a symptom of strained ICU capacity with demand exceeding the capacity [2]. Premature discharge of patients out of hours may cause insufficient handover and monitoring because the ward or step-down unit often have lower staffing out of hours and may lack necessary equipment for monitoring. Therefore, out-of-hours discharge is a frequently used indicator for ICU quality of care [2].In an article recently published in Intensive Care Medicine, Vollam and colleagues presented results from a well-conducted systematic review and meta-analysis examining the association between out-of-hours discharge from the ICU and readmission and hospital mortality, respectively [3]. The review and meta-analyses were thoroughly planned and the protocol was previously published [4]. The review included 18 observational studies with a total of 1,191,178 patients and found out-ofhours discharge to be associated with a 30% increased risk of readmission and 39% increased risk of in-hospital death.The current meta-analysis underscores that patients discharged from the ICU out of hours comprise a highrisk group, which is in itself important information. The obvious next question is whether readmission and mortality rate could be reduced by avoiding out-of-hours discharge. This would probably require more ICU beds and any benefit of longer ICU stay should outweigh the increased risk of ICU complications such as nosocomial infections. To answer this question is not easy. Although the current large meta-analysis provides precise estimates of the association, systematic variation from bias and confounding is not reduced with increased sample size. It is therefore crucial to consider other factors associated with both out-of-hours discharge and mortality, i.e

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supporting

confidence: 79%

supporting

confidence: 72%

“…

…”

mentioning

confidence: 99%

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Out-of-hours discharge from intensive care: certain about uncertainty

Christiansen

2018

Intensive Care Med

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“…Several studies showed a relationship between daytime and weekday of discharge from ICU and outcome. They confirmed that unplanned discharges from the ICU during night-time and on weekends were independent risk factors for readmission to the ICU and increased mortality (18,23,24). Others confirmed high age, severity of illness on the day of admission to the ICU and day of discharge from the ICU as well as comorbidities as independent risk factors (8,(25)(26)(27).…”

Section: Discussionmentioning

confidence: 90%

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Hamsen

Drotleff

Lefering

et al. 2020

Preprint

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Background Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as "failure to rescue" of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.Methods Retrospective analysis of the TraumaRegister DGU® with data from 2015-2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 hours but died later on.Results A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6,576 patients (8.0%) died during their hospital stay. Out of those, 5,481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.Conclusions 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may represent patients that died of potentially avoidable or treatable complications.

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“…Several studies showed a relationship between daytime and weekday of discharge from ICU and outcome. They con rmed that unplanned discharges from the ICU during night-time and on weekends were independent risk factors for readmission to the ICU and increased mortality (18,23,24). Others con rmed older age, severity of illness on the day of admission to the ICU and day of discharge from the ICU as well as comorbidities as independent risk factors (8,(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Hamsen

Drotleff

Lefering

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundMost trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.MethodsRetrospective analysis of the TraumaRegister DGU® with data from 2015-2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 hours but died later on.ResultsA total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6,576 patients (8.0%) died during their hospital stay. Out of those, 5,481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.Conclusions17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may represent patients that died of potentially avoidable or treatable complications.

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Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis

Cited by 43 publications

References 49 publications

Out-of-hours discharge from intensive care: certain about uncertainty

Out-of-hours discharge from intensive care: certain about uncertainty

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Mortality of severely injured patients after ICU discharge: An underestimated problem?

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