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What can be learned from crude intensive care unit mortality? Methodological implications.

Charles Weissman1, Peter Vernon van Heerden2, Charles L Sprung1

  • 1Department of Anesthesiology, Critical Care Medicine and Pain Management, Israel; Hospital Administration, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.

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|July 17, 2020
PubMed
Summary

Limited administrative data can reveal detailed ICU mortality patterns over time. Analyzing this data enhances understanding beyond simple crude mortality rates, showing how survival chances change with length of stay.

Keywords:
Administrative DataIntensive Care UnitMortalityMortality RateSurvival

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Area of Science:

  • Critical Care Medicine
  • Health Services Research
  • Biostatistics

Background:

  • Administrative data offers a potentially rich source for understanding patient outcomes.
  • Crude mortality rates provide a basic overview but may obscure important temporal trends.

Purpose of the Study:

  • To demonstrate the utility of limited administrative data for analyzing intensive care unit (ICU) mortality and survival.
  • To explore temporal patterns in ICU mortality beyond simple overall rates.

Main Methods:

  • Retrospective analysis of prospectively collected administrative data from a university medical center's General ICU.
  • Inclusion of 16,022 patients (87,624 patient-days) over 23 years, focusing on length-of-stay, survival/mortality, and referring service.

Main Results:

  • 28% of deaths occurred on ICU day 1; overall ICU day 1 mortality was 2%, with a crude mortality rate of 8.6%.
  • Mortality rates increased over the first 5 ICU days, plateaued until day 50, then decreased.
  • The internal medicine subgroup showed a distinct pattern of steadily increasing mortality over the initial 14 ICU days.

Conclusions:

  • Simple calculations from administrative data can significantly enhance the information derived from crude mortality rates.
  • Temporal mortality patterns vary with length of ICU stay and patient subgroups, underscoring the limitations of relying solely on overall crude mortality figures.