VARIATIONS IN MORTALITY AND LENGTH OF STAY IN INTENSIVE-CARE UNITS
VARIATIONS IN MORTALITY AND LENGTH OF STAY IN INTENSIVE-CARE UNITS
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DOI：
10.7326/0003-4819-118-10-199305150-00001
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发表时间：
1993-05-15
影响因子：
39.2
通讯作者：
DRAPER, EA
中科院分区：
文献类型：
--
作者：
KNAUS, WA;WAGNER, DP;DRAPER, EA
目的：评估住院死亡率和重症监护室（ICU）住院时间的变化量，这些变化可以通过ICU入院时的临床数据来解释。设计：初始队列研究。设置：40家医院的42个ICU，包括随机选择的26家医院和自愿参加研究的14家大型三级护理医院。参与者：连续样本16622名患者和17440名ICU入院患者，测量和主要结果：在ICU第一天记录了每个ICU平均415名入院患者的选定人口统计学特征、合并症和特定生理变量的数据;出院状况记录患者的死亡率（死亡或存活）和ICU住院时间;记录单个ICU的实际住院死亡率与预测住院死亡率的比值、标准化死亡率比值和实际ICU住院时间与预测住院时间的比值。42个单位的未校正住院死亡率从6.4%到40%不等，90%（R2 = 0.90）的这种变化可归因于入院时的患者特征。标准死亡率从0.67到1.25不等。平均未调整的ICU住院时间从3.3天到7.3天不等，78%的变化（R2 = 0.78）归因于患者和选定的机构特征。表现最好的病房的住院时间比为0.88，而表现最差的病房的住院时间比为1.21。结论：临床医生可以利用现有的入院数据来调整不同ICU患者严重程度和类型的差异。这些数据应该允许精确的评估和比较ICU的有效性和效率，这在本研究中有很大的不同，并导致改进的风险预测和评估新的医疗实践的方法。
Objective: To evaluate the amount of variation in in-hospital mortality and length of intensive care unit (ICU) stay that can be accounted for by clinical data available at ICU admission.Design: Inception cohort study.Setting: Forty-two ICUs in 40 hospitals, including 26 hospitals that were randomly selected and 14 large tertiary care hospitals that volunteered for the study.Participants: A consecutive sample of 16 622 patients and 17 440 ICU admissions.Measurements and Main Outcomes: Data on selected demographic characteristics, comorbidity, and specific physiologic variables were recorded during the first ICU day for an average of 415 admissions at each ICU; hospital discharge status (dead or alive) and length of ICU stay were recorded for individual patients; and the ratio of actual to predicted in-hospital mortality, standardized mortality ratios, and the ratio of actual to predicted length of ICU stay were recorded for individual ICUs.Results: Unadjusted in-hospital mortality rates for the 42 units varied from 6.4% to 40%, and 90% (R2 = 0.90) of this variation was attributable to patient characteristics at admission. The standard mortality ratio varied from 0.67 to 1.25. The mean unadjusted length of ICU stay varied from 3.3 to 7.3 days, and 78% of the variation (R2 = 0.78) was attributed to patient and selected institutional characteristics. The best performing unit had a length of stay ratio of 0.88, whereas the poorest performing unit had a ratio of 1.21.Conclusions: Clinicians can use readily available admission data to adjust for considerable variations in patient severity and type in different ICUs. Such data should permit precise evaluation and comparison of ICU effectiveness and efficiency, which varied substantially in this study, and result in improved methods of risk prediction and evaluation of new medical practices.