Differences in critical care practice between an industrialized and a developing country

Few data are available on intensive care unit (ICU) patient populations and critical care medicine practices in developing countries.

This prospective study evaluated differences in patient characteristics, ICU practice, and outcome between the ICUs of a Mongolian 400-bed tertiary university hospital (MonICU) and an Austrian 429-bed secondary hospital (AutICU). Demographics, chronic health status, clinical parameters, disease and therapeutic severity scores, and outcome were documented for all patients admitted to the two ICUs during a period of four and a half months. Standard tests and multiple regression analysis were used for statistical analysis.

A total of 203 critically ill patients were admitted to MonICU and 257 to AutICU. MonICU patients had fewer chronic diseases than AutICU patients (0.9 +/- 0.8 vs. 2.7 +/- 1.5, P < 0.001) but more frequently suffered from tuberculosis (2.5% vs. 0%, P = 0.01) and more frequently had never been medically examined before ICU admission (10.8% vs. 0%, P < 0.001). Admission diagnoses differed both in type and relative proportions in the two ICUs (P < 0.001). Admission of MonICU patients was more frequently unplanned (69% vs. 50.2%, P < 0.001), and although disease was more severe in these patients they received fewer therapeutic interventions than the AutICU patients. Overall mortality was higher in the MonICU patients (19.7 vs. 6.2%, P < 0.001).

Patient characteristics and ICU practices varied significantly between the two ICUs. Mortality was substantially greater at MonICU, particularly among patients suffering from multiple-organ dysfunction. Strategies to improve the care of critically ill patients at MonICU should address both system- and staff-related problems, improve acceptance of the ICU service among physicians of other disciplines and upgrade the training of ICU staff.