The epidemiology of chronic critical illness in the United States*.
The epidemiology of chronic critical illness in the United States*.
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DOI：
10.1097/ccm.0000000000000710
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发表时间：
2015-03
影响因子：
8.8
通讯作者：
ProVent Study Group Investigators
中科院分区：
文献类型：
--
作者：
Kahn JM;Le T;Angus DC;Cox CE;Hough CL;White DB;Yende S;Carson SS;ProVent Study Group Investigators
慢性危重病的流行病学特征尚不明确。我们试图确定美国慢性危重病的发病率、结局和相关费用。基于人群的队列研究，使用2004年至2009年美国医疗保健成本和利用项目的数据。马萨诸塞州、北卡罗来纳州、内布拉斯加州、纽约和华盛顿的急症护理医院。符合慢性危重病共识定义的成人和儿童患者，包括6种合格临床疾病之一（长期急性机械通气、气管切开术、卒中、创伤性脑损伤、脓毒症或严重伤口）加上至少8天的重症监护室治疗。没有。在研究期间入住重症监护室的3，235，741人中，有246，151人（7.6%）符合慢性危重病的共识定义。最常见的合格条件是长期急性机械通气（72.0%的合格入院）和败血症（63.7%的合格入院）。在通过败血症符合慢性危重病标准的患者中，48.5%的感染是社区获得性的，51.5%是医院获得性的。住院死亡率为30.9%，在研究期间变化不大。总体人群发病率为34.4/100，000。发病率随年龄变化很大，在75-79岁的人群中，发病率最高，为每10万人82.1例，但随后下降，同时符合条件的患者在第8天前死亡率上升。外推到整个美国，我们估计2009年共有380，001例病例，107，880例住院死亡和260亿美元的住院相关费用。使用基于共识的定义，慢性危重病的发病率、住院死亡率和费用是巨大的。慢性危重病在老年人中特别常见，尽管在非常老的患者中发病率下降，部分原因是潜在合格患者的早期死亡率增加。
The epidemiology of chronic critical illness is not well characterized. We sought to determine the incidence, outcomes and associated costs of chronic critical illness in the United States. Population-based cohort study using data from the United States Healthcare Costs and Utilization Project from 2004 to 2009. Acute care hospitals in Massachusetts, North Carolina, Nebraska, New York and Washington. Adult and pediatric patients meeting a consensus-derived definition for chronic critical illness, which included one of 6 eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis or severe wounds) plus at least 8 days in an intensive care unit. None. Out of 3,235,741 admissions to an intensive care unit during the study period, 246,151 (7.6%) met the consensus definition for chronic critical illness. The most common eligibility conditions were prolonged acute mechanical ventilation (72.0% of eligible admissions) and sepsis (63.7% of eligible admissions). Among patients meeting chronic critical illness criteria through sepsis, the infections were community-acquired in 48.5% and hospital acquired in 51.5%. In-hospital mortality was 30.9% with little change over the study period. The overall population-based incidence was 34.4 per 100,000. The incidence varied substantially with age, peaking at 82.1 per 100,000 individuals aged 75-79 but then declining coincident with a rise in mortality before day 8 in otherwise eligible patients. Extrapolating to the entire United States, for 2009 we estimated a total of 380,001 cases; 107,880 in-hospital deaths and $26 billion in hospital-related costs. Using a consensus-based definition, the incidence, hospital mortality and costs of chronic critical illness are substantial. Chronic critical illness is particularly common in the elderly, although in very old patients the incidence declines, in part due to an increase in early mortality among potentially eligible patients.