Mortality among appropriately referred patients refused admission to intensive-care units.
Background The provision of intensive care is a perplexing issue for clinicians and the public.
Concerns about the apparent lack of beds and the appropriateness of the patients admitted are tempered by the high cost of providing this service.
As part of a study commissioned by the UK Department of Health, we tested the hypothesis that there is excess mortality among patients who are refused admission to intensive-care units.
Methods All referrals to six intensive-care units with different numbers of beds were monitored during a 3-month period.
Data on mortality 90 days after first referral were obtained from family physicians for all patients known to be alive at hospital discharge.
We adjusted, where possible, for confounding, including for age, sex, appropriateness of referral, disease severity, surgery and emergency categories, and bed provision.
We did multivariate analysis by multiple logistic regression to compare the adjusted 90-day mortality rates for patients who were refused admission and for those admitted.
Findings 480 patients were admitted and 165 were refused admission. 90 days after referral there had been 178 (37%) deaths among the admitted group and 75 (46%) among the refused group.
After multivariate adjustment, 113 patients appropriately referred for intensive care but refused admission to their first-choice intensive-care unit had a relative risk of death of 1.6 (95% CI 1. O-2. (...)
Mots-clés Pascal : Unité soin intensif, Refus, Hospitalisation, Urgence, Royaume Uni, Europe, Epidémiologie, Mortalité, Homme
Mots-clés Pascal anglais : Intensive care unit, Denial, Hospitalization, Emergency, United Kingdom, Europe, Epidemiology, Mortality, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0379749
Code Inist : 002B30A01A2. Création : 12/09/1997.