Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia
Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia
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DOI：
10.1001/jama.2015.11068
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发表时间：
2015-09-22
影响因子：
120.7
通讯作者：
Cooke, Colin R.
中科院分区：
文献类型：
--
作者：
Valley, Thomas S.;Sjoding, Michael W.;Cooke, Colin R.
重要性 在重症监护需求不确定的患者中，入住重症监护病房 (ICU) 与死亡率和费用的关系尚不清楚。 目的 评估入住 ICU 与老年肺炎患者结局之间的关系。 设计、环境和患者 对 2010 年至 2012 年美国 2988 家急性护理医院收治的 Medicare 受益人（年龄 > 64 岁）进行回顾性队列研究。入住 ICU 与入住普通病房。 主要结果和测量 主要结果是 30 天全因死亡率。次要结果包括医疗保险支出和医院费用。对患者和医院特征进行了调整，以考虑入住 ICU 和未入住 ICU 的患者之间的差异。为了解释不可测量的混杂因素，使用了一个工具变量——到 ICU 入院率高的医院（定义为 ICU 使用率前 2 个五分位的任何一家医院）的差异距离。 结果 在 1 112 394 名患有肺炎的医疗保险受益人中，有 328 404 人 (30%) 住进 ICU。在未经调整的分析中，入住 ICU 的患者的 30 天死亡率、医疗保险支出和住院费用显着高于入住普通医院病房的患者。居住距离比中位差异距离更近的患者 (n = 553 597)
IMPORTANCE Among patients whose need for intensive care is uncertain, the relationship of intensive care unit (ICU) admission with mortality and costs is unknown.OBJECTIVE To estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia.DESIGN, SETTING, AND PATIENTS Retrospective cohort study of Medicare beneficiaries (aged >64 years) admitted to 2988 acute care hospitals in the United States with pneumonia from 2010 to 2012.EXPOSURES ICU admission vs general ward admission.MAIN OUTCOMES AND MEASURES Primary outcomewas 30-day all-cause mortality. Secondary outcomes included Medicare spending and hospital costs. Patient and hospital characteristics were adjusted to account for differences between patients with and without ICU admission. To account for unmeasured confounding, an instrumental variable was used-the differential distance to a hospital with high ICU admission (defined as any hospital in the upper 2 quintiles of ICU use).RESULTS Among 1 112 394 Medicare beneficiaries with pneumonia, 328 404 (30%) were admitted to the ICU. In unadjusted analyses, patients admitted to the ICU had significantly higher 30-day mortality, Medicare spending, and hospital costs than patients admitted to a general hospital ward. Patients (n = 553 597) living closer than the median differential distance (