Institution-free days after critical illness: A multicenter retrospective study.

Adult Humans Critical Illness Retrospective Studies Intensive Care Units Critical Care Outcome Assessment, Health Care
Critical care Determinants Institution-free days Patient-centred outcomes

Journal

Journal of critical care
ISSN: 1557-8615
Titre abrégé: J Crit Care
Pays: United States
ID NLM: 8610642

Informations de publication

Date de publication:
04 2023
Historique:
received: 30 06 2022
revised: 31 12 2022
accepted: 03 01 2023
pubmed: 15 1 2023
medline: 25 2 2023
entrez: 14 1 2023
Statut: ppublish

Résumé

Patient-centered outcomes beyond mortality such as institution-free days (IFD) are becoming increasingly relevant in critical care trials. We calculated IFD using three definitions which differed in the way death and censoring of after-hospital deaths were handled analysing data from adult patient databases admitted to four ICUs of North Brisbane, Australia. Differences in distribution of IFD using different definitions were explored with descriptive statistics and histograms. Six pre-specified variables (age, illness severity, comorbidities index, elective status, surgical/medical admission and treatment limitations) were assessed and reported as determinants of IFDs for the proposed definitions. Data from 25,371 ICU admissions was analysed. The density distribution of IFD was bimodal with a peak at 0 days and a variable right-sided peak depending on the definition used. The mean IFD varied from 253 (standard deviation(SD) 151.3) to 295 (SD 116.2) depending on definition used. Multivariable zero-inflated negative binomial regression modelling showed that the six pre-specified variables had significant associations with IFD and their magnitude of effect varied with the definition used. IFD is a simple, easily measurable patient-centered outcome that varies depending on the definition used. Patient input should be sought to define the optimum definition and clinical use of IFD.

Sections du résumé

BACKGROUND
Patient-centered outcomes beyond mortality such as institution-free days (IFD) are becoming increasingly relevant in critical care trials.
METHODS
We calculated IFD using three definitions which differed in the way death and censoring of after-hospital deaths were handled analysing data from adult patient databases admitted to four ICUs of North Brisbane, Australia. Differences in distribution of IFD using different definitions were explored with descriptive statistics and histograms. Six pre-specified variables (age, illness severity, comorbidities index, elective status, surgical/medical admission and treatment limitations) were assessed and reported as determinants of IFDs for the proposed definitions.
RESULTS
Data from 25,371 ICU admissions was analysed. The density distribution of IFD was bimodal with a peak at 0 days and a variable right-sided peak depending on the definition used. The mean IFD varied from 253 (standard deviation(SD) 151.3) to 295 (SD 116.2) depending on definition used. Multivariable zero-inflated negative binomial regression modelling showed that the six pre-specified variables had significant associations with IFD and their magnitude of effect varied with the definition used.
CONCLUSIONS
IFD is a simple, easily measurable patient-centered outcome that varies depending on the definition used. Patient input should be sought to define the optimum definition and clinical use of IFD.

Identifiants

DOI: 10.1016/j.jcrc.2023.154253 PMID: 36640478
pubmed: 36640478
pii: S0883-9441(23)00002-3
doi: 10.1016/j.jcrc.2023.154253
pii:
doi:

Types de publication

Multicenter Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

154253

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare no competing interests.

Auteurs

Prashanti Marella (P)

Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Services, Queensland, Australia; Mater Clinical Unit, University of Queensland, Brisbane, Australia.

Kevin B Laupland (KB)

Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Department of Intensive Care Services, Royal Brisbane and Womens hospital, Brisbane, Queensland, Australia.

Kiran Shekar (K)

The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.

Alexis Tabah (A)

Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Queensland, Australia.

Felicity Edwards (F)

Queensland University of Technology (QUT), Brisbane, Queensland, Australia.

Mahesh Ramanan (M)

Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Services, Queensland, Australia; The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia. Electronic address: Mahesh.Ramanan@health.qld.gov.au.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Institution-free days after critical illness:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Institution-free days after critical illness:...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Institution-free days after critical illness:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Institution-free days after critical illness:...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Institution-free days after critical illness:...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Institution-free days after critical illness:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Institution-free days after critical illness:...