Case mix, outcome, and activity of admissions to intensive care units (ICUs) from emergency departments (EDs)
| Direct admissions to ICU from EDs (n = 9389) | Indirect admissions to ICU from EDs(n = 2879) | Non-ED ICU admissions(n = 34 319) | |
|---|---|---|---|
| *As defined by the presence of one or more of 16 defined conditions/therapies: biopsy proven cirrhosis, portal hypertension, hepatic encephalopathy, very severe cardiovascular disease, severe respiratory disease, acquired immune deficiency syndrome (AIDS), metastatic disease, acute myelogenous leukaemia or acute lymphocytic leukaemia or multiple myeloma, chronic myelogenous leukaemia or chronic lymphocytic leukaemia, lymphoma, congenital immunohumoral or cellular immune deficiency state, home ventilation, chronic renal replacement therapy, steroid treatment, radiotherapy, chemotherapy. | |||
| †Admissions aged under 16 years or staying less than eight hours in the ICU were excluded from the calculation of APACHE II scores and therefore based on eligible admissions 7930 (direct admissions to ICU from EDs), 2444 (indirect admissions to ICU from EDs), 30 824 (non-ED ICU admissions). | |||
| ‡Missing for 76 (0.8%) of direct admissions to ICU from EDs, for 15 (0.5%) of indirect admissions to ICU from EDs and for 276 (0.8%) of non-ED ICU admissions. | |||
| §In addition to admissions for burns or coronary artery bypass grafting (CABG) and direct transfers from another ICU for whom physiology data from the first 24 hours in an ICU were not available were excluded from the calculation of APACHE II probabilities, therefore, based on eligible admissions 7710 (direct admissions to ICU from EDs), 2424 (indirect admissions to ICU from EDs), 26 786 (non-ED ICU admissions). | |||
| ¶CMP ICU survivors only. | |||
| CMP, Case Mix Programme; CPR, cardiopulmonary resuscitation; IQR, interquartile range. | |||
| Case mix | |||
| Age in years, mean (SD) [% age under 16 years] | 49.2 (21.9) [4.8] | 55.6 (20.0) [3.4] | 60.4 (18.7) [2.6] |
| Female, n (%) | 3438 (36.6) | 1209 (42.0) | 14076 (41.0) |
| Past medical history present*, n (%) | 776 (8.3) | 467 (16.2) | 5655 (16.5) |
| Acute Physiology Score†, mean (SD) | 13.3 (7.4) | 14.8 (7.1) | 11.9 (6.3) |
| APACHE II Score†, mean (SD) | 16.2 (8.1) | 18.7 (7.9) | 16.3 (7.0) |
| Surgical admissions, n (%) | 1788 (19.0) | 0 | 19409 (56.6) |
| Emergency/urgent surgery, n (%) | 1718 (18.3) | 0 | 6966 (20.3) |
| Received CPR within 24 hours prior to admission to ICU‡, n (%) | 1546 (16.5) | 452 (15.7) | 2206 (6.4) |
| APACHE II probability of hospital death§, median (IQR) | 16.0 (6.3–37.9) | 25.8 (12.2–46.4) | 18.0 (8.5–35.4) |
| Outcome | |||
| ICU deaths/ultimate ICU deaths, n (%) | 2357 (25.1)/2464 (26.2) | 1010 (35.1)/1059 (36.8) | 6371 (18.6)/6645 (19.4) |
| Hospital deaths/ultimate hospital deaths, n (%) | 2930 (31.2)/3067 (32.7) | 1268 (44.0)/1337 (46.4) | 9346 (27.2)/9923 (28.9) |
| Activity | |||
| Admissions at night, n (%) | 3631 (38.7) | 932 (32.4) | 7561 (22.0) |
| Admissions at weekends, n (%) | 2844 (30.3) | 793 (27.5) | 6102 (17.8) |
| Total days in hospital prior to admission to ICU, median (IQR) | 0 (0–0) | 1 (0–2) | 2 (1–6) |
| Days (as a fraction of whole days) in CMP ICU, median (IQR)¶ | 1.5 (0.7–3.7) | 2.3 (0.9–7.3) | 1.6 (0.8–3.8) |
| Total days in ICU, median (IQR)¶ | 2 (1–5) | 3 (1–9) | 2 (1–4) |
| Total days in hospital, median (IQR)¶ | 10 (4–23) | 17 (9–35) | 18 (10–35) |