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Intensive care unit to unit capacity transfers are associated with increased mortality: an observational cohort study on patient transfers in the Swedish Intensive Care Register
Annals of Intensive Care ( IF 8.1 ) Pub Date : 2022-04-04 , DOI: 10.1186/s13613-022-01003-x
Fredric Parenmark 1, 2, 3 , Sten M Walther 3, 4
Affiliation  

Background

Transfers from one intensive care unit (ICU) to another ICU are associated with increased length of intensive care and hospital stay. Inter-hospital ICU transfers are carried out for three main reasons: clinical transfers, capacity transfers and repatriations. The aim of the study was to show that different ICU transfers differ in risk-adjusted mortality rate with repatriations having the least risk.

Results

Observational cohort study of adult patients transferred between Swedish ICUs during 3 years (2016–2018) with follow-up ending September 2019. Primary and secondary end-points were survival to 30 days and 180 days after discharge from the first ICU. Data from 75 ICUs in the Swedish Intensive Care Register, a nationwide intensive care register, were used for analysis (89% of all Swedish ICUs), covering local community hospitals, district general hospitals and tertiary care hospitals. We included adult patients (16 years or older) admitted to ICU and subsequently discharged by transfer to another ICU. Only the first admission was used. Exposure was discharge to any other ICU (ICU-to-ICU transfer), whether in the same or in another hospital. Transfers were grouped into three predefined categories: clinical transfer, capacity transfer, and repatriation. We identified 15,588 transfers among 112,860 admissions (14.8%) and analysed 11,176 after excluding 4112 repeat transfer of the same individual and 300 with missing risk adjustment. The majority were clinical transfers (62.7%), followed by repatriations (21.5%) and capacity transfers (15.8%). Unadjusted 30-day mortality was 25.0% among capacity transfers compared to 14.5% and 16.2% for clinical transfers and repatriations, respectively. Adjusted odds ratio (OR) for 30-day mortality were 1.25 (95% CI 1.06–1.49 p = 0.01) for capacity transfers and 1.17 (95% CI 1.02–1.36 p = 0.03) for clinical transfers using repatriation as reference. The differences remained 180 days post-discharge.

Conclusions

There was a large proportion of ICU-to-ICU transfers and an increased odds of dying for those transferred due to other reasons than repatriation.



中文翻译:

重症监护病房到单位容量的转移与死亡率增加有关:瑞典重症监护登记处患者转移的观察性队列研究

背景

从一个重症监护病房 (ICU) 转移到另一个 ICU 与重症监护时间和住院时间的增加有关。进行医院间 ICU 转移的主要原因有三个:临床转移、容量转移和遣返。该研究的目的是表明不同的ICU转移在风险调整后的死亡率方面存在差异,而遣返的风险最小。

结果

对 3 年(2016-2018 年)期间在瑞典 ICU 之间转移的成年患者进行的观察性队列研究,随访截至 2019 年 9 月。主要和次要终点是从第一个 ICU 出院后的 30 天和 180 天的生存期。来自瑞典重症监护登记处(全国重症监护登记处)中 75 个 ICU 的数据(占瑞典所有 ICU 的 89%)被用于分析,涵盖当地社区医院、地区综合医院和三级医院。我们纳入了入住 ICU 并随后通过转移到另一个 ICU 出院的成年患者(16 岁或以上)。只使用了第一次入场。暴露是出院到任何其他 ICU(ICU 到 ICU 转移),无论是在同一家医院还是在另一家医院。转移分为三个预定义类别:临床转移、能力转移、和遣返。我们在 112,860 名入院者(14.8%)中确定了 15,588 名转移,并在排除了 4112 名同一个人的重复转移和 300 名缺少风险调整的情况后分析了 11,176 名。大多数是临床转移(62.7%),其次是遣返(21.5%)和能力转移(15.8%)。在能力转移中,未经调整的 30 天死亡率为 25.0%,而临床转移和遣返分别为 14.5% 和 16.2%。30 天死亡率的调整优势比 (OR) 为 1.25 (95% CI 1.06–1.49 在能力转移中,未经调整的 30 天死亡率为 25.0%,而临床转移和遣返分别为 14.5% 和 16.2%。30 天死亡率的调整优势比 (OR) 为 1.25 (95% CI 1.06–1.49 在能力转移中,未经调整的 30 天死亡率为 25.0%,而临床转移和遣返分别为 14.5% 和 16.2%。30 天死亡率的调整优势比 (OR) 为 1.25 (95% CI 1.06–1.49p  = 0.01) 用于能力转移,1.17 (95% CI 1.02–1.36 p  = 0.03) 用于使用遣返作为参考的临床转移。差异在出院后 180 天仍然存在。

结论

有很大比例的 ICU 到 ICU 转移,并且由于遣返以外的其他原因转移的人的死亡几率增加。

更新日期:2022-04-04
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