Changes in intensive care from 1987 to 1997 - has outcome improved? A single centre study

To study changes in a single intensive care unit (ICU) over a 10 year period and to investigate possible concomitant changes in outcome.

The ICU populations in 1987 and 1997 in a university hospital.

Prospective and retrospective cohort study. The ICU database was used for comparison of the ICU populations, and SAPS II-estimated hospital survival was compared with observed survival. Three year follow-up survival (the Peoples Registry) was compared with population survival (Statistics Norway). In the year 2000 the Short Form 36 (SF 36) questionnaire was used for quality of life (QOL) measurement. Results were compared with a reference population.

None.

From 1987 to 1997 the numbers of patients and stays increased from 219 and 236 to 338 and 370. ICU activity per stay increased considerably, but length of stay remained unchanged (6.0 versus 5.9 days). The 1997 ICU patients were, on average, older (50.3 versus 46.0 years) and more severely ill (SAPS II 42.7 versus 34.7). They had a higher crude mortality, but the time from admission to when the observed mortality reached the predicted mortality was longer, indicating an increased survival length. Two years after intensive care, there was no excess mortality compared with population survival in either cohort. QOL was significantly reduced in both cohorts compared to population scores.

This study indicates that the increased intensive care activity over the 10 year period was associated with a prolonged severity-adjusted survival. QOL was still reduced 3 and 13 years after ICU, compared to population scores.