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The length of the hospital stay&#44; and the patient&#39;s state at hospital discharge were obtained from the hospital database&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">For statistical analysis purposes&#44; the categorical variables were expressed as frequencies and percentages and compared using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; Continuous variables were expressed as mean and standard deviation and compared using the Student&#39;s <span class="elsevierStyleItalic">t</span> test&#46; We stratified the population into deciles of mortality risk at admission and then compared it to the actual hospital mortality rate&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study spans through a period of seven years and is characterized by a homogeneous case-mix in hospital admissions where the ICU admission criteria remained invariable&#46; Four thousand nine hundred and seventeen &#40;4917&#41; patients were admitted &#40;average age 65&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5 years&#59; 64&#37; males&#41;&#46; The average length of the ICU stay was 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1 days and the average length of the hospital stay was 14&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;8 days&#46; Mortality risk &#40;SAPS3&#41; at admission was 27&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;9&#37; and 810 &#40;16&#46;5&#37;&#41; patients died at the ICU or at the ward after being discharged from the ICU which led to a standardized mortality ratio of 0&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">When patients were stratified into deciles of SAPS3 risk&#44; a biased population was seen with a higher percentage of low-risk patients &#40;risk<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#41; compared to high-risk patients &#40;risk<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41; &#40;1499 &#91;30&#46;5&#37;&#93; vs 929 &#91;18&#46;9&#37;&#93;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The length of the ICU stay was not homogeneous either &#40;low risk&#58; 2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2 days vs high risk&#58; 6&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows that the standardized mortality ratio was also distributed non-homogeneously dropping gradually with respect to lower deciles of the SAPS3&#44; from 0&#46;87 for SAPS3<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#37; to 0&#46;30 for SAPS3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">This study found that low-risk patients not only were not hurt by their ICU admission&#44; but that the survival benefit of low-risk patients was proportionally greater compared to high-risk patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our analyses are based on the predictive value of SAPS3 at admission&#46; The original SAPS3 was adapted to predict mortality in every level of risk while taking into consideration the geographical and developing area of the world where the patient received healthcare&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> For this reason&#44; part of our population&#39;s survival advantage compared to the predicted mortality rate may be due to the cumulative effects of not calibrating this tool across the years as it has already been proven&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> However&#44; none of the studies that evaluated this problem found that this error in the calibration affects differently based on the level of predicted risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Our period of observation was not long enough to be able to show time-dependent effects over the standardized mortality ratio&#46; On the other hand&#44; some patients spent one or more days at the ICU waiting to be hospitalized&#44; meaning that the survival benefit may be associated with the improvement reported and with admissions at semi-intensive care units&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> yet former studies do not suggest a greater benefit for low-risk patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Another problem here is the economic burden involved when admitting low-risk patients to an ICU&#46; We do not have direct data on costs&#44; but most studies suggest that the key factor here is the much shorter length of the ICU stay<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a> of low-risk patients&#46; We can only speculate whether there would be an equivalent survival advantage for low-risk patients in less expensive ICUs&#44; such as semi-intensive or &#8220;low intensity&#8221; units&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Our study suggests that ICU admissions involve survival benefits for low-risk patients as well&#44; which makes them eligible for admission too&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors</span><p id="par0085" class="elsevierStylePara elsevierViewall">Person responsible for this paper&#44; its concept and design&#58; RF&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Analysis and interpretation&#58; RF&#44; JMA&#44; IC&#44; OR&#44; SC&#44; and CS&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Manuscript writing&#58; RF&#46;</p></span></span>"
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            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical care delivery&#58; the importance of process of care and ICU structure to improved outcomes&#58; an update from the American College of Critical Care Medicine Task Force on models of critical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;J&#46; Weled"
                            1 => "L&#46;A&#46; Adzhigirey"
                            2 => "T&#46;M&#46; Hodgman"
                            3 => "R&#46;J&#46; Brilli"
                            4 => "A&#46; Spevetz"
                            5 => "A&#46;M&#46; Kline"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0000000000000978"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "1520"
                        "paginaFinal" => "1525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25803647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care unit admitting patterns in the Veterans affairs health care system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Chen"
                            1 => "M&#46; Render"
                            2 => "A&#46; Sales"
                            3 => "E&#46;H&#46; Kennedy"
                            4 => "W&#46; Wiitala"
                            5 => "T&#46;P&#46; Hofer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinternmed.2012.2606"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2012"
                        "volumen" => "172"
                        "paginaInicial" => "1220"
                        "paginaFinal" => "1226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22825806"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of a &#171;low-intensity&#187; versus &#171;high-intensity&#187; medical intensive care unit on patient outcomes in critically ill veterans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;P&#46; Singer"
                            1 => "J&#46; Kohlwes"
                            2 => "S&#46; Bent"
                            3 => "L&#46; Zimmerman"
                            4 => "M&#46;D&#46; Eisner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066610366933"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "233"
                        "paginaFinal" => "239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20444736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of SAPS II and SAPS 3 in intermediate care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Lucena"
                            1 => "F&#46; Alegre"
                            2 => "D&#46; Martinez-Urbistondo"
                            3 => "M&#46;F&#46; Landecho"
                            4 => "A&#46; Huerta"
                            5 => "A&#46; Garc&#237;a-Mouriz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0077229"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e77229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24130860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SAPS 3 &#8211; From evaluation of the patient to evaluation of the intensive care unit&#46; Part 2&#58; Development of a prognostic model for hospital mortality at ICU admission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Moreno"
                            1 => "P&#46;G&#46; Metnitz"
                            2 => "E&#46; Almeida"
                            3 => "B&#46; Jordan"
                            4 => "P&#46; Bauer"
                            5 => "R&#46;A&#46; Campos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-005-2763-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "1345"
                        "paginaFinal" => "1355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16132892"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between intensive care unit utilization during hospitalization and costs&#44; use of invasive procedures&#44; and mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;W&#46; Chang"
                            1 => "M&#46;F&#46; Shapiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamainternmed.2016.4298"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Intern Med"
                        "fecha" => "2016"
                        "volumen" => "176"
                        "paginaInicial" => "1492"
                        "paginaFinal" => "1499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27532500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The predictive performance of the SAPS II and SAPS 3 scoring systems&#58; a retrospective analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Katsounas"
                            1 => "I&#46; Kamacharova"
                            2 => "B&#46; Tyczynski"
                            3 => "H&#46; Eggebrecht"
                            4 => "R&#46; Erbel"
                            5 => "A&#46; Canbay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2016.01.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2016"
                        "volumen" => "33"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26883275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Opening of a respiratory intermediate care unit in a general hospital&#58; impact on mortality and other outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Confalonieri"
                            1 => "R&#46; Trevisan"
                            2 => "M&#46; Demsar"
                            3 => "L&#46; Lattuada"
                            4 => "C&#46; Longo"
                            5 => "R&#46; Cifaldi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000433557"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2015"
                        "volumen" => "90"
                        "paginaInicial" => "235"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26160422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implications of ICU triage decisions on patient mortality&#58; a cost-effectiveness analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;L&#46; Edbrooke"
                            1 => "C&#46; Minelli"
                            2 => "G&#46;H&#46; Mills"
                            3 => "G&#46; Iapichino"
                            4 => "A&#46; Pezzi"
                            5 => "D&#46; Corbella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc10029"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2011"
                        "volumen" => "15"
                        "paginaInicial" => "R56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21306645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Kahn"
                            1 => "G&#46;D&#46; Rubenfeld"
                            2 => "J&#46; Rohrbach"
                            3 => "B&#46;D&#46; Fuchs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MLR.0b013e31817d9342"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "paginaInicial" => "1226"
                        "paginaFinal" => "1233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19300312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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Scientific Letter
Should intensive care admission be restricted to the most severely ill patients?
¿Se debe restringir el ingreso en cuidados intensivos solo a los pacientes más graves?
R. Fernandeza,b,c,
Corresponding author
rfernandezf@althaia.cat

Corresponding author.
, J.M. Alcoverroa, I. Catalána, O. Rubioa, S. Canoa, C. Subiràa
a Servicio de Medicina Intensiva, Hospital Sant Joan de Déu-Fundació Althaia, Manresa, Barcelona, Spain
b Universitat Internacional de Catalunya, Barcelona, Spain
c CIBERES, Madrid, Spain
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The length of the hospital stay&#44; and the patient&#39;s state at hospital discharge were obtained from the hospital database&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">For statistical analysis purposes&#44; the categorical variables were expressed as frequencies and percentages and compared using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; Continuous variables were expressed as mean and standard deviation and compared using the Student&#39;s <span class="elsevierStyleItalic">t</span> test&#46; We stratified the population into deciles of mortality risk at admission and then compared it to the actual hospital mortality rate&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study spans through a period of seven years and is characterized by a homogeneous case-mix in hospital admissions where the ICU admission criteria remained invariable&#46; Four thousand nine hundred and seventeen &#40;4917&#41; patients were admitted &#40;average age 65&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5 years&#59; 64&#37; males&#41;&#46; The average length of the ICU stay was 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1 days and the average length of the hospital stay was 14&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;8 days&#46; Mortality risk &#40;SAPS3&#41; at admission was 27&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;9&#37; and 810 &#40;16&#46;5&#37;&#41; patients died at the ICU or at the ward after being discharged from the ICU which led to a standardized mortality ratio of 0&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">When patients were stratified into deciles of SAPS3 risk&#44; a biased population was seen with a higher percentage of low-risk patients &#40;risk<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#41; compared to high-risk patients &#40;risk<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41; &#40;1499 &#91;30&#46;5&#37;&#93; vs 929 &#91;18&#46;9&#37;&#93;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The length of the ICU stay was not homogeneous either &#40;low risk&#58; 2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2 days vs high risk&#58; 6&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows that the standardized mortality ratio was also distributed non-homogeneously dropping gradually with respect to lower deciles of the SAPS3&#44; from 0&#46;87 for SAPS3<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#37; to 0&#46;30 for SAPS3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">This study found that low-risk patients not only were not hurt by their ICU admission&#44; but that the survival benefit of low-risk patients was proportionally greater compared to high-risk patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our analyses are based on the predictive value of SAPS3 at admission&#46; The original SAPS3 was adapted to predict mortality in every level of risk while taking into consideration the geographical and developing area of the world where the patient received healthcare&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> For this reason&#44; part of our population&#39;s survival advantage compared to the predicted mortality rate may be due to the cumulative effects of not calibrating this tool across the years as it has already been proven&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> However&#44; none of the studies that evaluated this problem found that this error in the calibration affects differently based on the level of predicted risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Our period of observation was not long enough to be able to show time-dependent effects over the standardized mortality ratio&#46; On the other hand&#44; some patients spent one or more days at the ICU waiting to be hospitalized&#44; meaning that the survival benefit may be associated with the improvement reported and with admissions at semi-intensive care units&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> yet former studies do not suggest a greater benefit for low-risk patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Another problem here is the economic burden involved when admitting low-risk patients to an ICU&#46; We do not have direct data on costs&#44; but most studies suggest that the key factor here is the much shorter length of the ICU stay<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a> of low-risk patients&#46; We can only speculate whether there would be an equivalent survival advantage for low-risk patients in less expensive ICUs&#44; such as semi-intensive or &#8220;low intensity&#8221; units&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Our study suggests that ICU admissions involve survival benefits for low-risk patients as well&#44; which makes them eligible for admission too&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors</span><p id="par0085" class="elsevierStylePara elsevierViewall">Person responsible for this paper&#44; its concept and design&#58; RF&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Analysis and interpretation&#58; RF&#44; JMA&#44; IC&#44; OR&#44; SC&#44; and CS&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Manuscript writing&#58; RF&#46;</p></span></span>"
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              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical care delivery&#58; the importance of process of care and ICU structure to improved outcomes&#58; an update from the American College of Critical Care Medicine Task Force on models of critical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;J&#46; Weled"
                            1 => "L&#46;A&#46; Adzhigirey"
                            2 => "T&#46;M&#46; Hodgman"
                            3 => "R&#46;J&#46; Brilli"
                            4 => "A&#46; Spevetz"
                            5 => "A&#46;M&#46; Kline"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0000000000000978"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "1520"
                        "paginaFinal" => "1525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25803647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care unit admitting patterns in the Veterans affairs health care system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Chen"
                            1 => "M&#46; Render"
                            2 => "A&#46; Sales"
                            3 => "E&#46;H&#46; Kennedy"
                            4 => "W&#46; Wiitala"
                            5 => "T&#46;P&#46; Hofer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinternmed.2012.2606"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2012"
                        "volumen" => "172"
                        "paginaInicial" => "1220"
                        "paginaFinal" => "1226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22825806"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of a &#171;low-intensity&#187; versus &#171;high-intensity&#187; medical intensive care unit on patient outcomes in critically ill veterans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;P&#46; Singer"
                            1 => "J&#46; Kohlwes"
                            2 => "S&#46; Bent"
                            3 => "L&#46; Zimmerman"
                            4 => "M&#46;D&#46; Eisner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066610366933"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "233"
                        "paginaFinal" => "239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20444736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of SAPS II and SAPS 3 in intermediate care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Lucena"
                            1 => "F&#46; Alegre"
                            2 => "D&#46; Martinez-Urbistondo"
                            3 => "M&#46;F&#46; Landecho"
                            4 => "A&#46; Huerta"
                            5 => "A&#46; Garc&#237;a-Mouriz"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0077229"
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                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e77229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24130860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SAPS 3 &#8211; From evaluation of the patient to evaluation of the intensive care unit&#46; Part 2&#58; Development of a prognostic model for hospital mortality at ICU admission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Moreno"
                            1 => "P&#46;G&#46; Metnitz"
                            2 => "E&#46; Almeida"
                            3 => "B&#46; Jordan"
                            4 => "P&#46; Bauer"
                            5 => "R&#46;A&#46; Campos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-005-2763-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "1345"
                        "paginaFinal" => "1355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16132892"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between intensive care unit utilization during hospitalization and costs&#44; use of invasive procedures&#44; and mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;W&#46; Chang"
                            1 => "M&#46;F&#46; Shapiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamainternmed.2016.4298"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Intern Med"
                        "fecha" => "2016"
                        "volumen" => "176"
                        "paginaInicial" => "1492"
                        "paginaFinal" => "1499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27532500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The predictive performance of the SAPS II and SAPS 3 scoring systems&#58; a retrospective analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "I&#46; Kamacharova"
                            2 => "B&#46; Tyczynski"
                            3 => "H&#46; Eggebrecht"
                            4 => "R&#46; Erbel"
                            5 => "A&#46; Canbay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2016.01.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2016"
                        "volumen" => "33"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26883275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Opening of a respiratory intermediate care unit in a general hospital&#58; impact on mortality and other outcomes"
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                            2 => "M&#46; Demsar"
                            3 => "L&#46; Lattuada"
                            4 => "C&#46; Longo"
                            5 => "R&#46; Cifaldi"
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1159/000433557"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2015"
                        "volumen" => "90"
                        "paginaInicial" => "235"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26160422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implications of ICU triage decisions on patient mortality&#58; a cost-effectiveness analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;L&#46; Edbrooke"
                            1 => "C&#46; Minelli"
                            2 => "G&#46;H&#46; Mills"
                            3 => "G&#46; Iapichino"
                            4 => "A&#46; Pezzi"
                            5 => "D&#46; Corbella"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc10029"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2011"
                        "volumen" => "15"
                        "paginaInicial" => "R56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21306645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Kahn"
                            1 => "G&#46;D&#46; Rubenfeld"
                            2 => "J&#46; Rohrbach"
                            3 => "B&#46;D&#46; Fuchs"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "doi" => "10.1097/MLR.0b013e31817d9342"
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                        "tituloSerie" => "Med Care"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "paginaInicial" => "1226"
                        "paginaFinal" => "1233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19300312"
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Article information
ISSN: 21735727
Original language: English
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2021 March 67 39 106
2021 February 53 30 83
2021 January 53 17 70
2020 December 49 17 66
2020 November 35 10 45
2020 October 47 19 66
2020 September 49 18 67
2020 August 52 12 64
2020 July 29 8 37
2020 June 41 7 48
2020 May 52 6 58
2020 April 43 3 46
2020 March 34 10 44
2020 February 93 25 118
2020 January 65 16 81
2019 December 30 17 47
2019 November 4 1 5
2019 September 2 4 6
2019 July 1 2 3
2019 May 2 4 6
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?