Outcomes of Early, Late, and No Admission to the Intensive Care Unit for Patients Hospitalized with Community‐acquired Pneumonia

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ACADEMIC EMERGENCY MEDICINE 2012; 19:294–303 © 2012 by the Society for Academic Emergency Medicine
Abstract

Objectives:  The objective was to compare outcomes associated with early, late, and no admission to the intensive care unit (ICU) for patients hospitalized with community‐acquired pneumonia (CAP).

Methods:  This was a post hoc analysis of the original data from the Emergency Department Community‐Acquired Pneumonia (EDCAP) and Pneumocom‐1 prospective multicenter cohort studies of adult patients hospitalized with CAP. Propensity score–adjusted analysis was used to compare 28‐day mortality and hospital length of stay (LOS) for 199, 144, and 2,215 patients with early (i.e., ICU admission on the day of emergency department [ED] presentation), late, and no ICU admission.

Results:  Unadjusted 28‐day mortality rates were 13.1, 19.4, and 5.7% for early, late, and no ICU admissions, respectively (p < 0.001). After adjusting for quintile of propensity score, the odds of 28‐day mortality were higher for late ICU admissions relative to early ICU admissions (odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.42 to 4.90), and no ICU admissions (OR = 3.40; 95% CI = 2.11 to 5.48), but did not differ between early and no ICU admissions (OR = 1.29; 95% CI = 0.79 to 2.09). The median hospital LOS was 10 days for early (interquartile range [IQR] = 7 to 18), 15 days for late (IQR 9 to 23), and 6 days (IQR 4 to 9) for no ICU admissions (p < 0.001).

Conclusions:  This study suggests that late but not early admission to the ICU is associated with higher 28‐day mortality for patients hospitalized with CAP. Patients admitted to the ICU have longer hospital LOS in comparison to those managed on the wards, particularly if they are admitted late to the ICU.

ACADEMIC EMERGENCY MEDICINE 2012; 19:#–# © 2012 by the Society for Academic Emergency Medicine

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1553-2712.2012.01301.x

Affiliations: 1: From the Service d’urgence, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier (BR, AS), Créteil, France; the Université Paris 12, Faculté de Médecine (BR, CBB, AS), Créteil, France; Réanimation Médicale, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier (CBB), Créteil, France; the Servei d’Atenció Continuada USAC, Institut Català d’Oncologia, Hospital Duran i Reynals, 08907 L’Hospitalet de Llobregat (EC), Barcelona, Spain; the Emergency Department, Centre Hospitalier de Montauban (CN), Montauban, France; the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (MJF), Pittsburgh, PA; the Division of General Internal Medicine, Department of Medicine (MJF), and the Department of Emergency Medicine (DMY), University of Pittsburgh, Pittsburgh, PA; the Quality of Care Unit, Centre Hospitalier Universitaire de Grenoble (JL), Grenoble, France; TIMC UMR 5525 CNRS Université Joseph Fourier-Grenoble 1 (JL), Grenoble, France. 2: From the Service d’urgence, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier (BR, AS), Créteil, France; the Université Paris 12, Faculté de Médecine (BR, CBB, AS), Créteil, France; Réanimation Médicale, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier (CBB), Créteil, France; the Servei d’Atenció Continuada USAC, Institut Català d’Oncologia, Hospital Duran i Reynals, 08907 L’Hospitalet de Llobregat (EC), Barcelona, Spain; the Emergency Department, Centre Hospitalier de Montauban (CN), Montauban, France; the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (MJF), Pittsburgh, PA; the Division of General Internal Medicine, Department of Medicine (MJF), and the Department of Emergency Medicine (DMY), University of Pittsburgh, Pittsburgh, PA; the Quality of Care Unit, Centre Hospitalier Universitaire de Grenoble (JL), Grenoble, France; TIMC UMR 5525 CNRS Université Joseph Fourier-Grenoble 1 (JL), Grenoble, France.

Publication date: March 1, 2012

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