| Title |
Effect of ICU strain on timing of limitations in life-sustaining therapy and on death
|
|---|---|
| Published in |
Intensive Care Medicine, February 2016
|
| DOI | 10.1007/s00134-016-4240-8 |
| Pubmed ID | |
| Authors |
May Hua, Scott D. Halpern, Nicole B. Gabler, Hannah Wunsch |
| Abstract |
The effect of capacity strain in an ICU on the timing of end-of-life decision-making is unknown. We sought to determine how changes in strain impact timing of new do-not-resuscitate (DNR) orders and of death. Retrospective cohort study of 9891 patients dying in the hospital following an ICU stay ≥72 h in Project IMPACT, 2001-2008. We examined the effect of ICU capacity strain (measured by standardized census, proportion of new admissions, and average patient acuity) on time to initiation of DNR orders and time to death for all ICU decedents using fixed-effects linear regression. Increases in strain were associated with shorter time to DNR for patients with limitations in therapy (predicted time to DNR 6.11 days for highest versus 7.70 days for lowest quintile of acuity, p = 0.02; 6.50 days for highest versus 7.77 days for lowest quintile of admissions, p < 0.001), and shorter time to death (predicted time to death 7.64 days for highest versus 9.05 days for lowest quintile of admissions, p < 0.001; 8.28 days for highest versus 9.06 days for lowest quintile of census, only in closed ICUs, p = 0.006). Time to DNR order significantly mediated relationships between acuity and admissions and time to death, explaining the entire effect of acuity, and 65 % of the effect of admissions. There was no association between strain and time to death for decedents without a limitation in therapy. Strains in ICU capacity are associated with end-of-life decision-making, with shorter times to placement of DNR orders and death for patients admitted during high-strain days. |
X Demographics
The data shown below were collected from the profiles of 14 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 6 | 43% |
| United States | 4 | 29% |
| Canada | 1 | 7% |
| Switzerland | 1 | 7% |
| Unknown | 2 | 14% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 7 | 50% |
| Practitioners (doctors, other healthcare professionals) | 3 | 21% |
| Scientists | 3 | 21% |
| Science communicators (journalists, bloggers, editors) | 1 | 7% |
Mendeley readers
The data shown below were compiled from readership statistics for 84 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 1% |
| Unknown | 83 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 17 | 20% |
| Other | 10 | 12% |
| Researcher | 9 | 11% |
| Student > Postgraduate | 6 | 7% |
| Student > Doctoral Student | 5 | 6% |
| Other | 25 | 30% |
| Unknown | 12 | 14% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 36 | 43% |
| Nursing and Health Professions | 6 | 7% |
| Engineering | 5 | 6% |
| Social Sciences | 5 | 6% |
| Agricultural and Biological Sciences | 3 | 4% |
| Other | 8 | 10% |
| Unknown | 21 | 25% |
Attention Score in Context
This research output has an Altmetric Attention Score of 9. 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 11 December 2019.
All research outputs
#4,423,324
of 25,918,104 outputs
Outputs from Intensive Care Medicine
#2,384
of 5,524 outputs
Outputs of similar age
#72,361
of 414,104 outputs
Outputs of similar age from Intensive Care Medicine
#21
of 97 outputs
Altmetric has tracked 25,918,104 research outputs across all sources so far. Compared to these this one has done well and is in the 82nd percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,524 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 29.5. This one has gotten more attention than average, scoring higher than 56% of its peers.
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We're also able to compare this research output to 97 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 78% of its contemporaries.