Resource allocation in neonatal and medical ICUs : Epidemiology and rationing at the extremes of life.
This study compared resource allocation to patients who eventually die In neonatal ICUs (NICUs) and adult medical ICUs (MICUs).
It was performed via retrospective, chart review study at ICUs at the University of Chicago-an inner city, tertiary care, academic medical center.
All patients were admitted to the neonatal, general medical, or coronary ICU during 1 calendar yr.
Overall mortality in the NICU (66/827 ; 7.9%) was significantly lower than in the adult ICUs (219/1320 ; 16.5%) (p<0.001).
However, mortality for the smallest newborns (<751 g ; 51% mortality) was higher than for the oldest adults (>84 yr ; 30% mortality) (p=0.05).
Fifty-six percent (37/66) of all neonates who died in the NICU did so within the first 48 hr of life.
In contrast, nearly two-thirds (134/219) of adult ICU deaths occurred after 48 hours in the ICU (p<0.02).
The percentage of ICU bed-days devoted to nonsurviving adults (28.8%) was significantly larger than the percentage of NICU bed-days devoted to nonsurviving babies (7.8%). Even among babies at greatest risk to die (birth weight<751 g), the percentage of NICU bed-days allocated to nonsurviving infants was less than 20%. In contrast, for the oldest ICU patients (>84 yr) this value exceeded 50%, for ICU patients>84 yr old who required mechanical ventilation, the percentage of ICU bed-days allocated to nonsurvivors approached 90%. (...)
Mots-clés Pascal : Allocation ressource, Economie santé, Survie, Etats Unis, Amérique du Nord, Amérique, Nouveau né, Homme, Vieillard, Unité soin intensif
Mots-clés Pascal anglais : Resource allocation, Health economy, Survival, United States, North America, America, Newborn, Human, Elderly, Intensive care unit
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0407863
Code Inist : 002B27B14C. Création : 19/12/1997.