Impact of the premature discharge on hospital mortality after a stay in an intensive care unit
Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos
M. Rodríguez-Carvajalest;
, D. Mora, A. Doblas, M. García, P. Domínguez, A. Tristancho, M. Herrera
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Unidad de Cuidados Intensivos Polivalente, Hospital Juan Ramón Jiménez, Huelva, Spain
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Colmenero" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Colmenero" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572711700170?idApp=WMIE" "url" => "/21735727/0000003500000003/v1_201212101041/S2173572711700170/v1_201212101041/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Impact of the premature discharge on hospital mortality after a stay in an intensive care unit" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "149" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Rodríguez-Carvajal, D. Mora, A. Doblas, M. García, P. Domínguez, A. Tristancho, M. Herrera" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Rodríguez-Carvajal" "email" => array:1 [ 0 => "mjrcarvajal@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">est;</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Mora" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Doblas" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "García" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Domínguez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Tristancho" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Herrera" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Cuidados Intensivos Polivalente, Hospital Juan Ramón Jiménez, Huelva, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "est;" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-08-12" "fechaAceptado" => "2011-01-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec10641" "palabras" => array:6 [ 0 => "Intensive care unit" 1 => "Patient discharge" 2 => "Withdrawing treatment" 3 => "In-hospital mortality" 4 => "Patient readmission" 5 => "Outcome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec10640" "palabras" => array:6 [ 0 => "UCI" 1 => "Altas no programadas" 2 => "LET" 3 => "Mortalidad hospitalaria post-UCI" 4 => "Readmisión" 5 => "SOFA" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality.</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors.</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 10-bed general ICU in a 540-bed tertiary-care community hospital.</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome.</p> <span class="elsevierStyleSectionTitle">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">None.</p> <span class="elsevierStyleSectionTitle">Main variables</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of lifesustaining treatments (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>14.02 4.6–42.6), readmissions to ICU (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>3.46 1.76–6.78), premature discharge (OR=2.6 1.06–4.41), higher organ failure score on discharge from the ICU (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>1.16 1.01–1.32) and age (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>1.03 1.01–1.05). Readmission rates and post-ICU length of stay were similar among patients with premature and normal discharge (7.3% vs. 8.2%, P<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>.68 and 16.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.7 days vs. 18.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21.3 days, respectively, P<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>162).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of critically ill patients.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI.</p> <span class="elsevierStyleSectionTitle">Diseño</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI.</p> <span class="elsevierStyleSectionTitle">Ámbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas.</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.</p> <span class="elsevierStyleSectionTitle">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ninguna.</p> <span class="elsevierStyleSectionTitle">Principales variables de interés</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>14,02 4,6–42,6), las readmisiones (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>3,46 1,76–6,78), las altas no programadas (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>2,16 1,06–4,41), la puntuación de fallos orgánicos al alta de UCI (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>1,16 1,01–1,32) y la edad (OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>1,03 1,01–1,05). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>0,68 y 16, 7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,7 frente a 18,7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21,3 días, respectivamente; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>0,162).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 12 | 21 |
| 2024 October | 42 | 62 | 104 |
| 2024 September | 25 | 36 | 61 |
| 2024 August | 38 | 52 | 90 |
| 2024 July | 29 | 41 | 70 |
| 2024 June | 28 | 27 | 55 |
| 2024 May | 35 | 37 | 72 |
| 2024 April | 34 | 42 | 76 |
| 2024 March | 25 | 30 | 55 |
| 2024 February | 31 | 50 | 81 |
| 2024 January | 20 | 49 | 69 |
| 2023 December | 22 | 42 | 64 |
| 2023 November | 22 | 20 | 42 |
| 2023 October | 18 | 44 | 62 |
| 2023 September | 23 | 32 | 55 |
| 2023 August | 18 | 27 | 45 |
| 2023 July | 23 | 31 | 54 |
| 2023 June | 21 | 17 | 38 |
| 2023 May | 17 | 17 | 34 |
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