Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill

Nicholas E. Ingraham; Victor Vakayil; Kathryn M. Pendleton; Alexandria J. Robbins; Rebecca L. Freese; Elise F. Palzer; Anthony Charles; R. Adams Dudley; Christopher J. Tignanelli

doi:10.1177/0885066620982905

Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill

Nicholas E. Ingraham, Victor Vakayil, Kathryn M. Pendleton, Alexandria J. Robbins, Rebecca L. Freese, Elise F. Palzer, Anthony Charles, R. Adams Dudley, Christopher J. Tignanelli

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Abstract

PURPOSE: With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them.

STUDY DESIGN AND METHODS: A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS).

RESULTS: The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease.

CONCLUSION: Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.

Original language	English (US)
Pages (from-to)	185-194
Number of pages	10
Journal	Journal of Intensive Care Medicine
Volume	37
Issue number	2
DOIs	https://doi.org/10.1177/0885066620982905
State	Published - Feb 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Grant funding was provided by: University of Minnesota’s Critical Care Research and Programmatic Development Program (NEI), NIH NHLBI T32HL07741 (NEI), University of Minnesota CTSI via NIH NCATS UL1TR000114. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
We would like to thank Cerner Corporation and Laura Freeseman-Freeman for the use of APACHE Outcomes data for research purposes. The authors would like to thank Drs. Jeffrey G. Chipman, MD and Melissa E. Brunsvold, MD for their constant wisdom, advice, and support related to this project. Their insights and guidance were pivotal to ensuring an informative and quality project was completed. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Grant funding was provided by: University of Minnesota’s Critical Care Research and Programmatic Development Program (NEI), NIH NHLBI T32HL07741 (NEI), University of Minnesota CTSI via NIH NCATS UL1TR000114. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© The Author(s) 2020.

Keywords

diagnosis
hospitalization
intensive care units
morbidity
mortality
running head: ICU admission and mortality trends
trends
Length of Stay
Intensive Care Units
Humans
Critical Illness
Hospitalization
Retrospective Studies

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Journal Article

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10.1177/0885066620982905

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@article{1504ce61bf0a4febb2878b67dca2e6a9,

title = "Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill",

abstract = "PURPOSE: With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them.STUDY DESIGN AND METHODS: A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS).RESULTS: The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease.CONCLUSION: Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.",

keywords = "diagnosis, hospitalization, intensive care units, morbidity, mortality, running head: ICU admission and mortality trends, trends, Length of Stay, Intensive Care Units, Humans, Critical Illness, Hospitalization, Retrospective Studies",

author = "Ingraham, {Nicholas E.} and Victor Vakayil and Pendleton, {Kathryn M.} and Robbins, {Alexandria J.} and Freese, {Rebecca L.} and Palzer, {Elise F.} and Anthony Charles and Dudley, {R. Adams} and Tignanelli, {Christopher J.}",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Grant funding was provided by: University of Minnesota{\textquoteright}s Critical Care Research and Programmatic Development Program (NEI), NIH NHLBI T32HL07741 (NEI), University of Minnesota CTSI via NIH NCATS UL1TR000114. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: We would like to thank Cerner Corporation and Laura Freeseman-Freeman for the use of APACHE Outcomes data for research purposes. The authors would like to thank Drs. Jeffrey G. Chipman, MD and Melissa E. Brunsvold, MD for their constant wisdom, advice, and support related to this project. Their insights and guidance were pivotal to ensuring an informative and quality project was completed. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Grant funding was provided by: University of Minnesota{\textquoteright}s Critical Care Research and Programmatic Development Program (NEI), NIH NHLBI T32HL07741 (NEI), University of Minnesota CTSI via NIH NCATS UL1TR000114. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2022",

month = feb,

doi = "10.1177/0885066620982905",

language = "English (US)",

volume = "37",

pages = "185--194",

journal = "Journal of Intensive Care Medicine",

issn = "0885-0666",

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number = "2",

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TY - JOUR

T1 - Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill

AU - Ingraham, Nicholas E.

AU - Vakayil, Victor

AU - Pendleton, Kathryn M.

AU - Robbins, Alexandria J.

AU - Freese, Rebecca L.

AU - Palzer, Elise F.

AU - Charles, Anthony

AU - Dudley, R. Adams

AU - Tignanelli, Christopher J.

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Grant funding was provided by: University of Minnesota’s Critical Care Research and Programmatic Development Program (NEI), NIH NHLBI T32HL07741 (NEI), University of Minnesota CTSI via NIH NCATS UL1TR000114. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: We would like to thank Cerner Corporation and Laura Freeseman-Freeman for the use of APACHE Outcomes data for research purposes. The authors would like to thank Drs. Jeffrey G. Chipman, MD and Melissa E. Brunsvold, MD for their constant wisdom, advice, and support related to this project. Their insights and guidance were pivotal to ensuring an informative and quality project was completed. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Grant funding was provided by: University of Minnesota’s Critical Care Research and Programmatic Development Program (NEI), NIH NHLBI T32HL07741 (NEI), University of Minnesota CTSI via NIH NCATS UL1TR000114. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © The Author(s) 2020.

PY - 2022/2

Y1 - 2022/2

N2 - PURPOSE: With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them.STUDY DESIGN AND METHODS: A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS).RESULTS: The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease.CONCLUSION: Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.

AB - PURPOSE: With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them.STUDY DESIGN AND METHODS: A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS).RESULTS: The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease.CONCLUSION: Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.

KW - diagnosis

KW - hospitalization

KW - intensive care units

KW - morbidity

KW - mortality

KW - running head: ICU admission and mortality trends

KW - trends

KW - Length of Stay

KW - Intensive Care Units

KW - Humans

KW - Critical Illness

KW - Hospitalization

KW - Retrospective Studies

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DO - 10.1177/0885066620982905

M3 - Article

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SN - 0885-0666

VL - 37

SP - 185

EP - 194

JO - Journal of Intensive Care Medicine

JF - Journal of Intensive Care Medicine

IS - 2

ER -

Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill

Abstract

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