1
|
Suulamo U, Remes H, Tarkiainen L, Murphy M, Martikainen P. Excess winter mortality in Finland, 1971-2019: a register-based study on long-term trends and effect modification by sociodemographic characteristics and pre-existing health conditions. BMJ Open 2024; 14:e079471. [PMID: 38309756 PMCID: PMC10840061 DOI: 10.1136/bmjopen-2023-079471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Excess winter mortality is a well-established phenomenon across the developed world. However, whether individual-level factors increase vulnerability to the effects of winter remains inadequately examined. Our aim was to assess long-term trends in excess winter mortality in Finland and estimate the modifying effect of sociodemographic and health characteristics on the risk of winter death. DESIGN Nationwide register study. SETTING Finland. PARTICIPANTS Population aged 60 years and over, resident in Finland, 1971-2019. OUTCOME MEASURES Age-adjusted winter and non-winter death rates, and winter-to-non-winter rate ratios and relative risks (multiplicative interaction effects between winter and modifying characteristics). RESULTS We found a decreasing trend in the relative winter excess mortality over five decades and a drop in the series around 2000. During 2000-2019, winter mortality rates for men and women were 11% and 14% higher than expected based on non-winter rates. The relative risk of winter death increased with age but did not vary by income. Compared with those living with at least one other person, individuals in institutions had a higher relative risk (1.07, 95% CI 1.05 to 1.08). Most pre-existing health conditions did not predict winter death, but persons with dementia emerged at greater relative risk (1.06, 95% CI 1.04 to 1.07). CONCLUSIONS Although winter mortality seems to affect frail people more strongly-those of advanced age, living in institutions and with dementia-there is an increased risk even beyond the more vulnerable groups. Protection of high-risk groups should be complemented with population-level preventive measures.
Collapse
Affiliation(s)
- Ulla Suulamo
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- International Max Planck Research School for Population, Health and Data Science, Rostock, Germany
| | - Hanna Remes
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Lasse Tarkiainen
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Michael Murphy
- The London School of Economics and Political Science Department of Social Policy, London, UK
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
| |
Collapse
|
2
|
Shmelev A, Schwarzova K, Cunningham SC. Seasonality in General Surgery Hospitalizations and Procedures in the US: Workflow Implications. J Surg Res 2023; 288:51-63. [PMID: 36948033 DOI: 10.1016/j.jss.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/19/2023] [Accepted: 02/18/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Seasonality has been studied in select conditions treated by surgeons and internists, but is not well understood regarding overall procedural volume in general surgery. Furthermore, much of the literature is limited due to lack of use of seasonal-trend-decomposition analyses. METHODS All admissions with general surgery procedures were pooled from NIS 2002-2014, monthly hospitalization rates calculated, and seasonal-trend decomposition performed. RESULTS Emergent admissions, accounting for 9% of the average annual incidence, had more prominent seasonality than elective admissions. Inpatient surgical-procedural volume remained relatively stable throughout the year and decreased only in the third quarter. Procedures for acute intra-abdominal conditions and traumas peaked in summer months, while endoscopies, tracheostomies and gastrostomies peaked in winter months. CONCLUSIONS Many surgical pathologies and corresponding general-surgery procedures obey circannual patterns. Surgical workforce remains in high demand throughout the year except for fall and winter holidays. Understanding seasonal variation in such demand may be important for staffing and resource planning.
Collapse
Affiliation(s)
- Artem Shmelev
- Department of Surgery, Columbia University Medical Center, New York, New York.
| | - Klara Schwarzova
- Department of Surgery, Ascension Saint Agnes Healthcare, Baltimore, Maryland
| | | |
Collapse
|
3
|
Verlaat CW, Visser IH, Wubben N, Hazelzet JA, Lemson J, van Waardenburg D, van der Heide D, van Dam NA, Jansen NJ, van Heerde M, van der Starre C, van Asperen R, Kneyber M, van Woensel JB, van den Boogaard M, van der Hoeven J. Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands. Pediatr Crit Care Med 2017; 18:e155-e161. [PMID: 28178075 DOI: 10.1097/pcc.0000000000001086] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality. DESIGN Retrospective cohort study. SETTING Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012. PATIENTS Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5-32] d vs median, 3 [interquartile range, 2-5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97-5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40-9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08-2.58). CONCLUSIONS Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.
Collapse
Affiliation(s)
- Carin W Verlaat
- 1Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands. 2Dutch Pediatric Intensive Care Evaluation, Department of Pediatric Intensive Care, Erasmus Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Radboud University, Nijmegen, The Netherlands. 4Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. 5Department of Pediatric Intensive Care, Academic Hospital Maastricht, The Netherlands. 6Faculty Board Member, PICE Registry, the Netherlands. 7Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 8Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands. 9Department of Pediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. 10Department of Neonatal and Pediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands. 11Department of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands. 12Department of Pediatric Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. This work was performed at the Department of Pediatric Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Sipilä J, Kauko T, Kytö V, Stormi T, Rautava P. The quality of internal medicine hospital care during summer holiday season. J Eval Clin Pract 2014; 20:327-32. [PMID: 24779454 DOI: 10.1111/jep.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The July/August Phenomenon is a period when the quality of care in hospitals is thought to decrease due to summer vacation stand-ins and new staff. The results of studies on the veracity of this claim have been conflicting. This study investigates the situation in internal medicine. METHODS Registry data of patients treated in internal medicine wards between 1 July 2000 and 30 November 2009 were obtained and analysed. RESULTS There were no differences in mortality during the July admissions compared with those in November when adjusting for age, diagnosis, gender and year [for the overall data risk ratio (RR) = 1.10, 95% confidence interval (CI) 1.00-1.23, P = 0.06; for the university hospitals RR = 1.10, 95% CI 0.91-1.33, P = 0.34; for the non-university hospitals RR = 1.10, 95% CI 0.97-1.26, P = 0.13]. The duration of admission (overall mean 4.5, standard deviation 6.0) was equal between July and November when adjusted for age, diagnosis, gender and year in all groups (overall data: RR = 1.00, 95% CI 0.99-1.02, P = 0.83; university hospitals RR = 1.02, 95% CI 0.99-1.04, P = 0.13; non-university hospitals RR = 1.00, 95% CI 0.98-1.01, P = 0.67). CONCLUSIONS The quality of care in Finnish internal medicine wards in July seems to equal November. Our results do not support the existence of a July Phenomenon in Finland.
Collapse
Affiliation(s)
- Jussi Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland; Department of Neurology, University of Turku, Turku, Finland
| | | | | | | | | |
Collapse
|
5
|
Cheng KC, Lu CL, Chung YC, Huang MC, Shen HN, Chen HM, Zhang H. ICU service in Taiwan. J Intensive Care 2014; 2:8. [PMID: 25908981 PMCID: PMC4407432 DOI: 10.1186/2052-0492-2-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/06/2014] [Indexed: 12/21/2022] Open
Abstract
Background The aim of the study was to understand the current status of intensive care unit (ICU) in order to optimize the resources achieving the best possible care. Methods The study analyzed the status of ICU settings based on the Taiwan National Health Insurance database between March 2004 and February 2009. Results A total of 1,028,364 ICU patients were identified. The age was 65 ± 18 years, and 61% of the patients were male. The total ICU bed occupancy rate was 83.8% which went up to 87.3% during winter. The ICU bed occupancy was 94.4% in major medical centers. The ICU stay was 6.5 ± 0.5 days, and the overall ICU mortality rate was 20.2%. The hospital stay was 16.4 ± 16.8 days, and the average cost of total hospital stay was approximately US$5,186 per patient. Conclusions The rate of ICU bed occupancy was dependent on seasonal changes, and it reached near full capacity in major medical centers in Taiwan. The ICU beds were distributed based on the categories of hospitals in order to achieve a reasonable cost efficiency. ICU faces many challenges to maintain and improve quality care because of the increasing cost of state-of-the-art technologies and dealing with aging population.
Collapse
Affiliation(s)
- Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan ; Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan ; Department of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Li Lu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yueh-Chih Chung
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Mei-Chen Huang
- Bureau of National Health Insurance Kao-Ping Branch, Kaohsiung, Taiwan
| | - Hsiu-Nien Shen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Min Chen
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Haibo Zhang
- The Keenan Research Centre in Biomedical Science, St. Michael's Hospital, Toronto, University of Toronto, Room 619, 209 Victoria Street, Toronto, Ontario M5B 1T8 Canada
| |
Collapse
|
6
|
Kaukonen KM, Vaara ST, Pettilä V, Bellomo R, Tuimala J, Cooper DJ, Krusius T, Kuitunen A, Reinikainen M, Koskenkari J, Uusaro A. Age of red blood cells and outcome in acute kidney injury. Crit Care 2013; 17:R222. [PMID: 24093554 PMCID: PMC4057274 DOI: 10.1186/cc13045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/08/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction Transfusion of red blood cells (RBCs) and, in particular, older RBCs has been associated with increased short-term mortality in critically ill patients. We evaluated the association between age of transfused RBCs and acute kidney injury (AKI), hospital, and 90-day mortality in critically ill patients. Methods We conducted a prospective, observational, predefined sub-study within the FINNish Acute Kidney Injury (FINNAKI) study. This study included all elective ICU admissions with expected ICU stay of more than 24 hours and all emergency admissions from September to November 2011. To study the age of RBCs, we classified transfused patients into quartiles according to the age of oldest transfused RBC unit in the ICU. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Results Out of 1798 patients, 652 received at least one RBC unit. The median [interquartile range] age of the oldest RBC unit transfused was 12 [11-13] days in the freshest quartile and 21 [17-27] days in the quartiles 2 to 4. On logistic regression, RBC age was not associated with the development of KDIGO stage 3 AKI. Patients in the quartile of freshest RBCs had lower crude hospital and 90-day mortality rates compared to those in the quartiles of older blood. After adjustments, older RBC age was associated with significantly increased risk for hospital mortality. Age, Simplified Acute Physiology Score II (SAPS II)-score without age points, maximum Sequental Organ Failure Assessment (SOFA) score and the total number of transfused RBC units were independently associated with 90-day mortality. Conclusions The age of transfused RBC units was independently associated with hospital mortality but not with 90-day mortality or KDIGO stage 3 AKI. The number of transfused RBC units was an independent risk factor for 90-day mortality.
Collapse
|
7
|
Effects of out-of-hours and winter admissions and number of patients per unit on mortality in pediatric intensive care. J Pediatr 2013; 163:1039-44.e5. [PMID: 23623513 DOI: 10.1016/j.jpeds.2013.03.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 02/18/2013] [Accepted: 03/20/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effect of out-of-hours and winter admissions, and unit size on risk adjusted mortality in pediatric intensive care. STUDY DESIGN A national pediatric intensive care clinical audit provided data on over 86000 admissions to 29 pediatric intensive care units (2006-2011). Multivariate logistic regression modeled risk adjusted mortality prior to discharge with out-of-hours (night, weekend, public holiday) admissions, admissions per unit, winter admission, and potential confounders, overall and separately for emergency and planned admissions. RESULTS Nearly one-half (47.1%) of admissions were out-of-hours (n = 40948) and 79.2% of those were emergencies. Mortality for all out-of-hours admissions was raised (OR 1.1; 95% CI 1.02-1.2; P = .013), accounted for by planned admissions (OR 1.99; 95% CI 1.67-2.37; P < .001) compared with a reduced risk for emergency admissions (OR 0.93; 95% CI 0.86-1.1; P = .07). Winter admissions were associated with increased risk. Unit size did not affect mortality. CONCLUSIONS A child admitted to pediatric intensive care as an out-of-hours emergency is not at increased risk of dying compared with a weekday daytime admission, indicating pediatric intensive care units provide consistent quality of care around the clock. Excess mortality in planned out-of-hours admissions may be explained by admissions following complex operations where risk-adjustment models underestimate the true probability of mortality. In winter, a time of seasonally high bed occupancy, there was an increased mortality risk, an effect which requires further investigation. Despite the different characteristics of small units, the absence of any effect of unit size on mortality suggests that number of admissions per unit does not influence standards of care.
Collapse
|
8
|
Abstract
OBJECTIVES We sought to describe the demographics, case mix, interventions, and clinical outcome of critically ill patients admitted to ICUs in Mainland China. DESIGN A 2-month (July 1, 2009, to August 31, 2009) prospective, observational cohort study. SETTING Twenty-two ICUs in Mainland China. PATIENTS Adult patients admitted to participating ICUs during the study period with an ICU length of stay >24 hrs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient characteristics, including demographics, underlying diseases, severity of illness, admission status, complications, intervention and treatment during ICU stay, and clinical outcome were recorded in case report form. The primary outcome measure was all-cause hospital mortality. Independent predictors for hospital mortality were determined with multivariate logistic regression analysis. One thousand two hundred ninety-seven patients met the inclusion criteria for the study, 821 (63.3%) were male, and mean age was 58.5 ± 19.2 yrs. Mean Acute Physiology and Chronic Health Evaluation II score was 18.0 ± 8.1, and mean Sequential Organ Failure Assessment score was 6.5 ± 3.8. One third of the patients were postoperative ICU admissions. Seven hundred sixty-five patients (59.0%) developed infections, followed by severe sepsis or septic shock (484, 37.3%), acute kidney injury (398, 30.7%), and acute lung injury/acute respiratory distress syndrome (351, 27.1%). Mechanical ventilation was used in almost three fourths of the patients, whereas any type of renal replacement therapy was used in 173 patients (13.3%). Hospital mortality was 20.3%. Multivariate logistic regression analysis found that Acute Physiology and Chronic Health Evaluation II score, solid tumor, severe sepsis/septic shock, acute lung injury/acute respiratory distress syndrome, and acute kidney injury were independent risk factors for hospital mortality. CONCLUSIONS Critically ill patients in ICUs in Mainland China exhibited a case mix similar to those of Western countries, although there are significant differences in intensive care unit admission rates and disease severity between Western and Chinese ICUs.
Collapse
|
9
|
Kastrup M, Nolting MJ, Ahlborn R, Braun JP, Grubitzsch H, Wernecke KD, Spies C. An electronic tool for visual feedback to monitor the adherence to quality indicators in intensive care medicine. J Int Med Res 2012; 39:2187-200. [PMID: 22289534 DOI: 10.1177/147323001103900615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Evidence-based medicine is often inadequately implemented in intensive care units (ICU); the aim of this study was to improve its implementation via a technical feedback system, using key performance indicators (KPI). The study evaluated 205 patients treated in a cardiac surgical ICU over a 6-month period (3 months before and 3 months after implementation of the feedback system). KPI adherence rates for sedation, delirium and pain monitoring, and completion of a weaning protocol before and after the implementation of the feedback system, were compared. Adherence rates for pain and delirium monitoring, and implementation of the weaning protocol, were significantly increased by the intervention. Adherence to KPIs for sedation, which were high at baseline, could not be further improved. Daily display of KPI implementation had a positive effect on adherence to standard operating procedures. Adherence to guidelines may be improved by using this feedback system as part of the clinical routine.
Collapse
Affiliation(s)
- M Kastrup
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
10
|
Santana Cabrera L, Sánchez-Palacios M, Uriarte Rodriguez A, Fernández Arroyo M, Martínez Cuéllar S, Lorenzo Torrent R. [Seasonal influence in characteristics of patients admitted to an intensive care unit]. Med Intensiva 2009; 34:102-6. [PMID: 20156706 DOI: 10.1016/j.medin.2009.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 06/23/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate seasonal variability in the epidemiology and the outcome of critical illness. DESIGN Retrospective analysis of prospectively collected data during the period 2001-2008. SETTING Polyvalent intensive care unit (ICU) of a tertiary hospital in the Canary Islands. PATIENTS Adult patients who were hospitalized in the ICU from the Emergency Department, according to the season period (spring, summer, autumn and winter). PRIMARY VARIABLES OF INTEREST Demographic data, clinical diagnosis on ICU admission, APACHE II, need of mechanical ventilation and, finally, the mortality were collected. RESULTS During the study period, 3,115 patients, coming from the Emergency Department, were hospitalized in our ICU. Of these, 21% were admitted during the summer, an incidence rate that is statistically lower than in other seasons of the year (P<0.001). We did not find any statistically significant differences between the four groups according to the age, type of patients, severity at the moment of admission to the ICU, according to the APACHE II score or in the mortality rate in the ICU. However, significant differences were found in regards to gender. Admission of women during the summer was higher than in winter (33% vs 27%, P=0.037). Average stay in the ICU of patients admitted in the summer was similar to winter (4.9 days vs 5.8 days; P=0.052). Need for mechanical ventilation and days it was required, by diagnostic groups, were similar between the summer and the winter. The multivariate analysis did not show independent variables associated with the seasonal period in which the patients were admitted. CONCLUSIONS The stability of our climate implies that this factor does not influence the prognosis of patients who are admitted with critical illness.
Collapse
Affiliation(s)
- L Santana Cabrera
- Servicio de Medicina Intensiva, Hospital Universitario Insular de Gran Canaria, Gran Canaria, España.
| | | | | | | | | | | |
Collapse
|
11
|
Capuzzo M, Scaramuzza A, Vaccarini B, Gilli G, Zannoli S, Farabegoli L, Felisatti G, Davanzo E, Alvisi R. Validation of SAPS 3 Admission Score and comparison with SAPS II. Acta Anaesthesiol Scand 2009; 53:589-94. [PMID: 19419351 DOI: 10.1111/j.1399-6576.2009.01929.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to validate the Simplified Acute Physiology Score SAPS 3 Admission Score (SAPS 3) and to compare its fit with that of SAPS II in an independent sample of patients admitted to a single-centre intensive care unit (ICU). METHODS The data for all adult patients consecutively admitted to an eight-bed ICU of a 700-bed university hospital between 1 January 2006 and 2 September 2007 were collected. SAPS II and SAPS 3 were computed, as well as the predicted hospital mortality. The calibration of SAPS II and SAPS 3, according to the general equation (GE), and equations for Southern Europe and Mediterranean countries (SE&MC), and Central and Western Europe (C&WE), were assessed by the goodness-of-fit Hosmer-Lemeshow H and C statistics. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were computed for SAPS II and SAPS 3 equations. RESULTS Six hundred and eighty-four patients were studied (males 63%). The median age was 73 (quartiles 65-80) years. The fit of SAPS 3 using the C&WE equation (H 13.49, P=0.095; C 12.73, P=0.121) as well as that of SAPS II was acceptable (H 6.02, P=0.644; C12.08, P=0.147), while SAPS 3 GE (H 23.36, P=0.002; C 22.37, P=0.004) and S&MC (H 25.73, P=0.001; C 26.19, P=0.001) did not fit well. SAPS 3 GE, SAPS 3 SE&M Countries and the SAPS II significantly over estimated the mortality. Only 95% CI of SMR for SAPS 3 C&WE included 1 (SMR 0.97; 95% CI 0.89-1.05). CONCLUSION Each ICU should identify the SAPS 3 equation most suitable for its case mix. The SAPS II model tended to overestimate the mortality.
Collapse
Affiliation(s)
- M Capuzzo
- Surgical, Anaesthetic and Radiological Sciences, Section of Anaesthesiology and Intensive Care, University Hospital of Ferrara, Ferrara, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Karlsson S, Varpula M, Ruokonen E, Pettilä V, Parviainen I, Ala-Kokko TI, Kolho E, Rintala EM. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med 2007; 33:435-43. [PMID: 17225161 DOI: 10.1007/s00134-006-0504-z] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 12/01/2006] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice. STUDY DESIGN A prospective study in 24 closed multidisciplinary ICUs in 21 hospitals (4 university and 17 tertiary hospitals) in Finland. PATIENTS All 4,500 consecutive ICU admission episodes were screened for severe sepsis during a 4-month period (1 November 2004 - 28 February 2005). The referral population was 3,743,225. RESULTS The severe sepsis criteria were fulfilled in 470 patients, who had 472 septic episodes. The incidence of severe sepsis in the ICUs in Finland was 0.38/1000 in the adult population (95% confidence interval 0.34-0.41). The mean ICU length of stay was 8.2+/-8.1 days. ICU, hospital, and 1-year mortality rates were 15.5%, 28.3%, and 40.9%, respectively. Respiratory failure requiring ventilation support was the most common organ failure (86.2%); septic shock was present in 77% and acute renal failure in 20.6% of cases. Activated protein C was given to only 15 of the 55 patients with indication (27%) and low-dose corticosteroids to 150 of 366 (41%) patients with septic shock. CONCLUSIONS This prospective study found the incidence of ICU-treated severe sepsis in Finland to be 0.38 per 1,000 of the population. The ICU and hospital mortalities were also lower than earlier reported in United States or Australia. Evidence-based sepsis therapies were not used as often as recommended.
Collapse
|