Document Type
Journal Article
Publication Date
2013
Journal
Critical Care
Volume
Volume 17
Inclusive Pages
Article number R81
Abstract
Introduction
A decrease in disease-specific mortality over the last twenty years has been reported for patients admitted to United States (US) hospitals, but data for intensive care patients are lacking. The aim of this study was to describe changes in hospital mortality and case-mix using clinical data for patients admitted to multiple US ICUs over the last 24 years.
Methods
We carried out a retrospective time series analysis of hospital mortality using clinical data collected from 1988 to 2012. We also examined the impact of ICU admission diagnosis and other clinical characteristics on mortality over time. The potential impact of hospital discharge destination on mortality was also assessed using data from 2001 to 2012.
Results
For 482,601 ICU admissions there was a 35% relative decrease in mortality from 1988 to 2012 despite an increase in age and severity of illness. This decrease varied greatly by diagnosis. Mortality fell by >60% for patients with chronic obstructive pulmonary disease, seizures and surgery for aortic dissection and subarachnoid hemorrhage. Mortality fell by 51% to 59% for six diagnoses, 41% to 50% for seven diagnoses, and 10% to 40% for seven diagnoses. The decrease in mortality from 2001 to 2012 was accompanied by an increase in discharge to post-acute care facilities and a decrease in discharge to home.
Conclusions
Hospital mortality for patients admitted to US ICUs has decreased significantly over the past two decades despite an increase in the severity of illness. Decreases in mortality were diagnosis specific and appear attributable to improvements in the quality of care, but changes in discharge destination and other confounders may also be responsible.
Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.
APA Citation
Zimmerman, J.E., Kramer, A.A., Knaus, W.A. (2013). Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Critical Care, 17:R81.
Peer Reviewed
1
Open Access
1
Comments
Reproduced with permission of BioMed Central Critical Care.