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    "titulo" => "Study of post-ICU mortality during 4 years (2006–2009). Analysis of the factors related to death in the ward after discharge from the ICU"
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        "titulo" => "Estudio de la mortalidad post-UCI durante 4 a&#241;os &#40;2006&#8211;2009&#41;&#46; An&#225;lisis de factores en relaci&#243;n con el fallecimiento en planta tras el alta de UCI"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To detect possible reasons for mortality of critical patients transferred from the ICU to the hospital wards and to analyze the possible attributable causes for such mortality&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational study of prospectively collected data&#44; analyzed retrospectively&#46;</p> <span class="elsevierStyleSectionTitle">Population</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cohort analysis of 5328 with consecutive admissions to our ICU&#44; whose evolution was followed up to hospital discharge or death&#46;</p> <span class="elsevierStyleSectionTitle">Period</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">From January 2006 to December 2009&#46;</p> <span class="elsevierStyleSectionTitle">Method</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">An analysis was made of differential significance of epidemiological&#44; clinical-care&#44; death risk estimate&#44; coincidence between ICU admissions reasons and causes of death after ICU discharge&#44; as well as limitation of health care effort incidence&#46; Inappropriate ICU discharge was considered to exist if the death occurred during the first 48 hours after ICU transfer&#44; without limitation of care effort&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 907 patients died &#40;SMR &#61; 0&#46;9&#59; 95&#37; CI&#44; 0&#46;87&#8211;0&#46;93&#41;&#44; 202 of whom died after ICU discharge &#40;3&#46;8&#37; of total sample and 22&#46;3&#37; of all deceased patients&#41;&#44; ward length of stay being 12&#46;4&#177;17&#46;9 days&#46; No significant differences were found between deaths in the ICU or post-ICU deaths regarding infective complications appearing after admission to the ICU&#46; Greater mortality was also not found in those re-admitted to the ICU after having been transferred to the ward&#46; It was verified that the cause of death in the ward did not significantly coincide with the cause of admission to the ICU&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Some mortality after ICU discharge is to be expected&#46; Our data do not allow us to attribute this mortality rate to care deficiencies &#40;inappropriate ICU discharges or deceased care in the wards&#41;&#46; The reasons for this mortality have a varied and variable explanation&#46; It mostly corresponds to an evolution of the patients differing from that expected when they were discharged from ICU&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Detectar posibles razones de la mortalidad de los pacientes cr&#237;ticos trasladados desde la UCI a las plantas del hospital y analizar las potenciales causas atribuibles de esta mortalidad&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de datos prospectivos analizados retrospectivamente&#46;</p> <span class="elsevierStyleSectionTitle">Muestra</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cohorte de 5&#46;328 pacientes ingresados consecutivamente en nuestro SMI cuya evoluci&#243;n se sigue hasta el fallecimiento o el alta hospitalaria&#46;</p> <span class="elsevierStyleSectionTitle">Per&#237;odo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2006 a diciembre de 2009&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de significaci&#243;n diferencial de datos epidemiol&#243;gicos&#44; cl&#237;nico-asistenciales&#44; de estimaci&#243;n de riesgo de muerte&#44; de coincidencia de diagn&#243;stico de causa de ingreso en UCI y de causa de fallecimiento y de incidencia de limitaci&#243;n de esfuerzo asistencial&#46; Se consider&#243; alta inadecuada de UCI si la muerte acontec&#237;a antes de las 48 h del traslado&#44; sin limitaci&#243;n de esfuerzo asistencial&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Fallecieron 907 pacientes &#40;tasa estandarizada de 0&#44;9&#59; IC del 95&#37;&#44; 0&#44;87&#8211;0&#44;93&#41; de los que 202 fallecieron tras el alta del SMI &#40;el 3&#44;8&#37; de la poblaci&#243;n total y el 22&#44;3&#37; de los fallecidos&#41;&#59; la estancia en planta post-UCI fue de 12&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;9 d&#237;as&#46; No se detectaron diferencias significativas entre los fallecidos en UCI o tras la estancia en UCI respecto a complicaciones infectivas aparecidas tras el ingreso&#46; Tampoco los reingresados en UCI tras el pase a planta presentaron una mayor mortalidad&#46; Se comprueba que la causa de muerte en planta no es significativamente coincidente con la causa de ingreso en UCI&#46;</p> <span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Cierta mortalidad de pacientes cr&#237;ticos tras el traslado desde UCI es un hecho habitual&#46; Nuestros datos no permiten atribuir esta mortalidad a deficiencias asistenciales &#40;altas inadecuadas o disminuci&#243;n de asistencia en planta&#41;&#46; Las razones para esta mortalidad tienen una explicaci&#243;n variada y variable&#44; y en su mayor&#237;a corresponden a evoluci&#243;n del paciente diferente de la previsible tras el traslado desde el SMI&#46;</p>"
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Study of post-ICU mortality during 4 years (2006–2009). Analysis of the factors related to death in the ward after discharge from the ICU
Estudio de la mortalidad post-UCI durante 4 años (2006–2009). Análisis de factores en relación con el fallecimiento en planta tras el alta de UCI
R. Abizanda Campos
Corresponding author
rabizandac@terra.es

Corresponding author.
, S. Altaba Tena, A. Belenguer Muncharaz, S. Más Font, A. Ferrándiz Sellés, L. Mateu Campos, J. de León Belmar
Servicio de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, Castellón, Spain
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To detect possible reasons for mortality of critical patients transferred from the ICU to the hospital wards and to analyze the possible attributable causes for such mortality&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational study of prospectively collected data&#44; analyzed retrospectively&#46;</p> <span class="elsevierStyleSectionTitle">Population</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cohort analysis of 5328 with consecutive admissions to our ICU&#44; whose evolution was followed up to hospital discharge or death&#46;</p> <span class="elsevierStyleSectionTitle">Period</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">From January 2006 to December 2009&#46;</p> <span class="elsevierStyleSectionTitle">Method</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">An analysis was made of differential significance of epidemiological&#44; clinical-care&#44; death risk estimate&#44; coincidence between ICU admissions reasons and causes of death after ICU discharge&#44; as well as limitation of health care effort incidence&#46; Inappropriate ICU discharge was considered to exist if the death occurred during the first 48 hours after ICU transfer&#44; without limitation of care effort&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 907 patients died &#40;SMR &#61; 0&#46;9&#59; 95&#37; CI&#44; 0&#46;87&#8211;0&#46;93&#41;&#44; 202 of whom died after ICU discharge &#40;3&#46;8&#37; of total sample and 22&#46;3&#37; of all deceased patients&#41;&#44; ward length of stay being 12&#46;4&#177;17&#46;9 days&#46; No significant differences were found between deaths in the ICU or post-ICU deaths regarding infective complications appearing after admission to the ICU&#46; Greater mortality was also not found in those re-admitted to the ICU after having been transferred to the ward&#46; It was verified that the cause of death in the ward did not significantly coincide with the cause of admission to the ICU&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Some mortality after ICU discharge is to be expected&#46; Our data do not allow us to attribute this mortality rate to care deficiencies &#40;inappropriate ICU discharges or deceased care in the wards&#41;&#46; The reasons for this mortality have a varied and variable explanation&#46; It mostly corresponds to an evolution of the patients differing from that expected when they were discharged from ICU&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Detectar posibles razones de la mortalidad de los pacientes cr&#237;ticos trasladados desde la UCI a las plantas del hospital y analizar las potenciales causas atribuibles de esta mortalidad&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de datos prospectivos analizados retrospectivamente&#46;</p> <span class="elsevierStyleSectionTitle">Muestra</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cohorte de 5&#46;328 pacientes ingresados consecutivamente en nuestro SMI cuya evoluci&#243;n se sigue hasta el fallecimiento o el alta hospitalaria&#46;</p> <span class="elsevierStyleSectionTitle">Per&#237;odo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2006 a diciembre de 2009&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de significaci&#243;n diferencial de datos epidemiol&#243;gicos&#44; cl&#237;nico-asistenciales&#44; de estimaci&#243;n de riesgo de muerte&#44; de coincidencia de diagn&#243;stico de causa de ingreso en UCI y de causa de fallecimiento y de incidencia de limitaci&#243;n de esfuerzo asistencial&#46; Se consider&#243; alta inadecuada de UCI si la muerte acontec&#237;a antes de las 48 h del traslado&#44; sin limitaci&#243;n de esfuerzo asistencial&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Fallecieron 907 pacientes &#40;tasa estandarizada de 0&#44;9&#59; IC del 95&#37;&#44; 0&#44;87&#8211;0&#44;93&#41; de los que 202 fallecieron tras el alta del SMI &#40;el 3&#44;8&#37; de la poblaci&#243;n total y el 22&#44;3&#37; de los fallecidos&#41;&#59; la estancia en planta post-UCI fue de 12&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;9 d&#237;as&#46; No se detectaron diferencias significativas entre los fallecidos en UCI o tras la estancia en UCI respecto a complicaciones infectivas aparecidas tras el ingreso&#46; Tampoco los reingresados en UCI tras el pase a planta presentaron una mayor mortalidad&#46; Se comprueba que la causa de muerte en planta no es significativamente coincidente con la causa de ingreso en UCI&#46;</p> <span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Cierta mortalidad de pacientes cr&#237;ticos tras el traslado desde UCI es un hecho habitual&#46; Nuestros datos no permiten atribuir esta mortalidad a deficiencias asistenciales &#40;altas inadecuadas o disminuci&#243;n de asistencia en planta&#41;&#46; Las razones para esta mortalidad tienen una explicaci&#243;n variada y variable&#44; y en su mayor&#237;a corresponden a evoluci&#243;n del paciente diferente de la previsible tras el traslado desde el SMI&#46;</p>"
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ISSN: 21735727
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