Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Kiekkas, Panagiotis; Tzenalis, Anastasios; Gklava, Vasiliki; Stefanopoulos, Nikolaos; Voyagis, G. S.; Αρέθα, Διαμάντω

doi:10.1155/2022/4083494

Cited by 24 publications

(15 citation statements)

References 55 publications

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“…A study of 102 critically ill patients showed that a shortage of ICU beds (65.1%) and holdups in radiological examination (15.1%) were common reasons for delayed admission [ 27 ]. A meta-analysis conducted by Keikkas et al [ 28 ] found that the main reasons for delayed ICU admission were an increase in the demand for ICU beds due to population aging and miscommunication among physicians; this study also found that patients with delayed admission tended to be older and had more comorbidities. Similarly, a study that investigated the association between the timing of ICU admission and outcomes in patients with pneumonia demonstrated that the decision to admit a patient to the ICU was often limited by the patient’s age, comorbidities, and premorbid functional status [ 29 ].…”

Section: Discussionmentioning

confidence: 54%

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Ahn¹,

Lee²,

Lee³

et al. 2023

j intensive care

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Background Based on sparse evidence, the current Surviving Sepsis Campaign guideline suggests that critically ill patients with sepsis be admitted to the intensive care unit (ICU) within 6 h. However, limited ICU bed availability often makes immediate transfer difficult, and it is unclear whether all patients will benefit from early admission to the ICU. Therefore, the purpose of this study was to determine the association between the timing of ICU admission and mortality in patients with hospital-onset sepsis. Methods This nationwide prospective cohort study analyzed patients with hospital-onset sepsis admitted to the ICUs of 19 tertiary hospitals between September 2019 and December 2020. ICU admission was classified as either early (within 6 h) or delayed (beyond 6 h). The primary outcome of in-hospital mortality was compared using logistic regression adjusted for key prognostic factors in the unmatched and 1:1 propensity-score-matched cohorts. Subgroup and interaction analyses assessed whether in-hospital mortality varied according to baseline characteristics. Results A total of 470 and 286 patients were included in the early and delayed admission groups, respectively. Early admission to the ICU did not significantly result in lower in-hospital mortality in both the unmatched (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 0.99–1.85) and matched cohorts (aOR, 1.38; 95% CI, 0.94–2.02). Subgroup analyses showed that patients with increasing lactate levels (aOR, 2.10; 95% CI, 1.37–3.23; P for interaction = 0.003), septic shock (aOR, 2.06; 95% CI, 1.31–3.22; P for interaction = 0.019), and those who needed mechanical ventilation (aOR, 1.92; 95% CI, 1.24–2.96; P for interaction = 0.027) or vasopressor support (aOR, 1.69; 95% CI, 1.17–2.44; P for interaction = 0.042) on the day of ICU admission had a higher risk of mortality with delayed admission. Conclusions Among patients with hospital-onset sepsis, in-hospital mortality did not differ significantly between those with early and delayed ICU admission. However, as early intensive care may benefit those with increasing lactate levels, septic shock, and those who require vasopressors or ventilatory support, admission to the ICU within 6 h should be considered for these subsets of patients.

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Section: Discussionmentioning

confidence: 54%

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Ahn¹,

Lee²,

Lee³

et al. 2023

j intensive care

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“…47,49,50 Delayed ICU admission is associated with higher mortality risk, suggesting potential improvements in resource allocation within the Western Cape healthcare system. 51,52 Furthermore, in the Western Cape, the median time to damage control surgery is 30.0 h. 47 Our study found that most deaths occurring between 4 and 24 h post injury occurred in the emergency unit, where the patient may be awaiting provision of critical care or pending transfer to higher levels of care, sub-surgical specialist, and/or theater. 11,53 These findings support the claim that delays in time from injury to definitive care are deleterious.…”

Section: Discussionmentioning

confidence: 67%

“…In the Western Cape, due to transfer to the tertiary or regional hospital the median time from injury to ICU admission is 17.3 h, compared to 5.4–7.0 h in other middle‐income countries 47,49,50 . Delayed ICU admission is associated with higher mortality risk, suggesting potential improvements in resource allocation within the Western Cape healthcare system 51,52 . Furthermore, in the Western Cape, the median time to damage control surgery is 30.0 h 47 .…”

Section: Discussionmentioning

confidence: 99%

Patterns of on‐scene and healthcare system trauma deaths in the Western Cape of South Africa

Finn,

Dixon,

Moreira

et al. 2023

World j. surg.

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BackgroundInjuries account for 8% or 4.4 million deaths annually worldwide, with 90% of injury deaths occurring in low‐ and middle‐income countries. Inter‐personal violence and road traffic injuries account for most injury deaths in South Africa, with rates among the highest globally. Understanding the location, timing, and factors of trauma deaths can identify opportunities to strengthen care.MethodsThis is a retrospective cross‐sectional secondary analysis of trauma deaths from 2021 to 2022 in the Western Cape of South Africa. Healthcare system trauma deaths were identified from a multicenter study paired with a dataset for on‐scene (i.e., prior to ambulance or hospital) trauma deaths in the same jurisdictions. We describe locations, timing, injury factors, and cause of death. We assess associations between those factors.ResultsThere were 2418 deaths, predominantly young men, with most (2274, 94.0%) occurring on‐scene. The most frequent mechanism of injury for all deaths was firearms (32.6%), followed by road traffic collisions (17.8%). On‐scene deaths (33.2%) were significantly more likely to be injured by firearms compared to healthcare system deaths (23.6%) (p‐value <0.01). Most healthcare system deaths within 4–24 h of injury occurred in a hospital emergency center. Among healthcare system decedents, half died in the emergency unit.ConclusionsWe identified a large burden of deaths from interpersonal violence and road traffic collisions, mostly on‐scene. In addition to primary prevention, shortening delays to care can improve mortality outcomes especially for deaths occurring within 4–24 h in emergency centers.

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“…This finding suggests that delayed presentation to care was potentially detrimental. Other studies show that delayed admission to the ICU is associated with increased mortality; an observational study showed that each 1-hour increase in delay was associated with an adjusted 3% increase in odds of hospital mortality ( 34 , 35 ). In our cohort, NHW were older and with more comorbidities and we suspect this is why mortality was not different between NHW and patients from racial and ethnic minority groups.…”

Section: Discussionmentioning

confidence: 99%

Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19

Kelly

Mohammed

Okin

et al. 2023

Critical Care Explorations

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IMPORTANCE:Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear. OBJECTIVES:We hypothesized that preferred language mediates the association between race, ethnicity and delays to care. DESIGN, SETTING AND PARTICIPANTS:Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020. MAIN OUTCOME AND MEASURES:Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics. RESULTS:Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un-or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71-2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission. CONCLUSIONS AND RELEVANCE:Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.

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Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Cited by 24 publications

References 55 publications

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Patterns of on‐scene and healthcare system trauma deaths in the Western Cape of South Africa

Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19

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