BACKGROUND:The utility of specialty care ICUs is debated. From a management/cost perspective having fewer larger ICUs is preferred. On the other hand, the impact of specialty ICU care on patient outcome is not known. Patients with intracerebral hemorrhage (ICH) are routinely admitted to both types of ICUs and thus would provide an opportunity to address this question. OBJECTIVE :To determine whether admissions to a specialty care ICU, or the organizational characteristics of the ICU or institution are related to outcome following acute ICH. DESIGN:Analysis of patient and ICU data prospectively collected by Project Impact (PI) from 51 participating ICUs across the country. METHODS:The records of 36,986 patients in the PI database were merged with records of 6,298 patients from a Neuro ICU collecting the same data over the same time frame. The impact of clinical (GCS, age, reason for admission, surgery), demographic (insurance, race, gender), ICU (size, number of ICH patients, presence of intensivist who sees all patients, clinical service), and institutional characteristics (size, location, Medical school, ACGME, CCM affiliation) on hospital mortality of patients with a primary diagnosis of ICH was assessed. RESULTS: Data from 42 ICUs and 1,038 patients were included. The 13 ICUs who admitted >20 patients accounted for 83% of the admissions with a mortality that ranged from 25-64%. Multivariate analysis adjusted for patient demographics, severity of ICH, ICU and institutional characteristics indicated that not being in a Neuro ICU was associated with a 3.3-fold increase in hospital mortality (OR 3.3,95% CI 1.16-9.64). Other factors associated with higher mortality were age (OR 1.03/yr 95% CI 1.02-1.04), GCS (OR 0.6/point 95% CI .57-.64), and number of patients admitted with ICH (OR 1.01/patient, 95% CI 1.00-1.02). CONCLUSIONS:For patients with acute ICH, admission to a specialty care ICU is associated with reduced risk of mortality.
|Journal||Critical care medicine|
|Issue number||12 SUPPL.|
|State||Published - Dec 1 1999|