| Title |
Emergency Department disposition decisions and associated mortality and costs in ICU patients with suspected infection
|
|---|---|
| Published in |
Critical Care, July 2018
|
| DOI | 10.1186/s13054-018-2096-8 |
| Pubmed ID | |
| Authors |
Shannon M. Fernando, Bram Rochwerg, Peter M. Reardon, Kednapa Thavorn, Andrew J. E. Seely, Jeffrey J. Perry, Douglas P. Barnaby, Peter Tanuseputro, Kwadwo Kyeremanteng |
| Abstract |
Following emergency department (ED) assessment, patients with infection may be directly admitted to the intensive care unit (ICU) or alternatively admitted to hospital wards or sent home. Those admitted to the hospital wards or sent home may experience future deterioration necessitating ICU admission. We used a prospectively collected registry from two hospitals within a single tertiary care hospital network between 2011 and 2014. Patient information, outcomes, and costs were stored in the hospital data warehouse. Patients were categorized into three groups: (1) admitted directly from the ED to the ICU; (2) initially admitted to the hospital wards, with ICU admission within 72 hours of initial presentation; or (3) sent home from the ED, with ICU admission within 72 hours of initial presentation. Using multivariable logistic regression, we sought to compare outcomes and total costs between groups. Total costs were evaluated using a generalized linear model. A total of 657 patients were included; of these, 338 (51.4%) were admitted directly from the ED to the ICU, 246 (37.4%) were initially admitted to the wards and then to the ICU, and 73 (11.1%) were initially sent home and then admitted to the ICU. In-hospital mortality was lowest among patients admitted directly to the ICU (29.5%), as compared with patients admitted to the ICU from wards (42.7%) or home (61.6%) (P < 0.001). As compared with direct ICU admission, disposition to the ward was associated with an adjusted OR of 1.75 (95% CI, 1.22-2.50; P < 0.01) for mortality, and disposition home was associated with an adjusted OR of 4.02 (95% CI, 2.32-6.98). Mean total costs were lowest among patients directly admitted to the ICU ($26,748), as compared with those admitted from the wards ($107,315) and those initially sent home ($71,492) (P < 0.001). Cost per survivor was lower among patients directly admitted to the ICU ($37,986) than either those initially admitted to the wards ($187,230) or those sent home ($186,390) (P < 0.001). In comparison with direct admission to the ICU, patients with suspected infection admitted to the ICU who have previously been discharged home or admitted to the ward are associated with higher in-hospital mortality and costs. |
X Demographics
The data shown below were collected from the profiles of 37 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 9 | 24% |
| United States | 4 | 11% |
| Colombia | 4 | 11% |
| Spain | 1 | 3% |
| Germany | 1 | 3% |
| Brazil | 1 | 3% |
| Australia | 1 | 3% |
| Qatar | 1 | 3% |
| United Kingdom | 1 | 3% |
| Other | 0 | 0% |
| Unknown | 14 | 38% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 18 | 49% |
| Scientists | 10 | 27% |
| Practitioners (doctors, other healthcare professionals) | 7 | 19% |
| Science communicators (journalists, bloggers, editors) | 2 | 5% |
Mendeley readers
The data shown below were compiled from readership statistics for 74 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 74 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 8 | 11% |
| Researcher | 8 | 11% |
| Student > Bachelor | 8 | 11% |
| Student > Master | 8 | 11% |
| Student > Doctoral Student | 6 | 8% |
| Other | 15 | 20% |
| Unknown | 21 | 28% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 27 | 36% |
| Nursing and Health Professions | 11 | 15% |
| Biochemistry, Genetics and Molecular Biology | 3 | 4% |
| Engineering | 3 | 4% |
| Social Sciences | 2 | 3% |
| Other | 4 | 5% |
| Unknown | 24 | 32% |
Attention Score in Context
This research output has an Altmetric Attention Score of 32. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 September 2021.
All research outputs
#1,240,863
of 25,385,509 outputs
Outputs from Critical Care
#1,049
of 6,555 outputs
Outputs of similar age
#26,170
of 341,012 outputs
Outputs of similar age from Critical Care
#29
of 79 outputs
Altmetric has tracked 25,385,509 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,555 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has done well, scoring higher than 83% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 341,012 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 92% of its contemporaries.
We're also able to compare this research output to 79 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 63% of its contemporaries.