Winter excess mortality in intensive care in the UK: an analysis of outcome adjusted for patient case mix and unit workload.


Harrison, DA; Lertsithichai, P; Brady, AR; Carpenter, JR; Rowan, K; (2004) Winter excess mortality in intensive care in the UK: an analysis of outcome adjusted for patient case mix and unit workload. Intensive care medicine, 30 (10). pp. 1900-7. ISSN 0342-4642 DOI: https://doi.org/10.1007/s00134-004-2390-6

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Abstract

OBJECTIVE: To investigate whether mortality in UK intensive care units is higher in winter than in non-winter and to explore the importance of variations in case mix and increased pressure on ICUs. DESIGN AND SETTING: Cohort study in 115 adult, general ICUs in England, Wales and Northern Ireland. PATIENTS AND PARTICIPANTS: 113,389 admissions from 1995 to 2000. MEASUREMENTS AND RESULTS: Hospital mortality following admission to ICU was compared between winter (December-February) and non-winter (March-November). The causes of any observed differences were explored by adjusting for the case mix of admissions and the workload of the ICUs. Crude hospital mortality was higher in winter. After adjusting for case mix using the APACHE II mortality probability this effect was reduced but still significant. When additional factors reflecting case mix and workload were introduced into the model, the overall effect of winter admission was no longer significant. Factors reflecting both the case mix of the individual patient and of the patients in surrounding beds were found to be significantly associated with outcome. After adjustment for other factors, the occupancy of the unit (proportion of beds occupied) was not significantly associated with mortality. CONCLUSIONS: The excess winter mortality observed in UK ICUs can be explained by variation in the case mix of admissions. Unit occupancy was not associated with mortality.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 15300367
Web of Science ID: 224613600008
URI: http://researchonline.lshtm.ac.uk/id/eprint/13956

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