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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2004

01-10-2004 | Original

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

Authors: David A. Harrison, Panuwat Lertsithichai, Anthony R. Brady, James R. Carpenter, Kathy Rowan

Published in: Intensive Care Medicine | Issue 10/2004

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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.
Appendix
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Literature
1.
Curwen M (1990/91) Excess winter mortality: a British phenomenon? Health Trends 4:169–175
2.
Laake K, Sverre JM (1996) Winter excess mortality: a comparison between Norway and England plus Wales. Age Ageing 25:343–348PubMed
3.
Kendrick S, Frame S, Povey C (1997) Beds occupied by emergency patients: long-term trends in patterns of short-term fluctuation in Scotland. Health Bull (Edinb) 55:167–175
4.
Keatinge WR (2002) Winter mortality and its causes. Int J Circumpolar Health 61:292–299PubMed
5.
Office for National Statistics (2002) Mortality statistics: general. Review of the Registrar General on deaths in England and Wales, 2000. Series DH1 no.33. Office for National Statistics, London
6.
Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K (2003) Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338CrossRefPubMed
7.
Garfield M, Ridley S, Kong A, Burns A, Blunt M, Gunning K (2001) Seasonal variation in admission rates to intensive care units. Anaesthesia 56:1136–1140CrossRefPubMed
8.
Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ (2000) Hospital mortality in relation to staff workload: a 4-year study in an adult intensive care unit. Lancet 356:185–189CrossRefPubMed
9.
UK Neonatal Staffing Study Group (2002) Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation. Lancet 359:99–107CrossRefPubMed
10.
Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142CrossRefPubMed
11.
Rowan K, Black N (2000) A bottom-up approach to performance indicators through clinician networks. Health Care UK, Spring:42–46
12.
Department of Health (2000) Comprehensive critical care: a review of adult critical care services. Department of Health, London
13.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed
14.
Leach CE, Blair PS, Fleming PJ, Smith IJ, Platt MW, Berry PJ, Golding J (1999) Epidemiology of SIDS and explained sudden infant deaths. CESDI SUDI Research Group. Pediatrics 104:e43PubMed
15.
Pell JP, Sirel J, Marsden AK, Cobbe SM (1999) Seasonal variations in out of hospital cardiopulmonary arrest. Heart 82:680–683PubMed
16.
Atkinson W, Harris J, Mills P, Moffat S, White C, Lynch O, Jones M, Cullinan P, Newman Taylor AJ (1999) Domestic aeroallergen exposures among infants in an English town. Eur Respir J 13:583–589CrossRefPubMed
17.
Sandberg S, Paton JY, Ahola S, McCann DC, McGuinness D, Hillary CR, Oja H (2000) The role of acute and chronic stress in asthma attacks in children. Lancet 356:982–987CrossRefPubMed
18.
Fullerton KJ, Crawford VLS (1999) The winter bed crisis: quantifying seasonal effects on hospital bed usage. Q J Med 92:199–206CrossRef
19.
Rowan KM (1992) Outcome comparison of intensive care units in Great Britain and Ireland using the APACHE II method. Thesis, University of Oxford
20.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 202:685–693PubMed
21.
Wunsch H, Mapstone J, Brady T, Hanks R, Rowan K (2004) Hospital mortality associated with day and time of admission to intensive care units. Intensive Care Med 30:895–901CrossRefPubMed
22.
Morales IJ, Peters SG, Afessa B (2003) Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med 31:858–863CrossRefPubMed
23.
Selker HP (1993) Systems for comparing actual and predicted mortality rates: characteristics to promote cooperation in improving hospital care. Ann Intern Med 118:820–822PubMed
24.
25.
Rutledge R (1996) The Injury Severity Score is unable to differentiate between poor care and severe injury. J Trauma 40:944–950PubMed
26.
Shann F, Pearson G, Slater A, Wilkinson K (1997) Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 23:201–207CrossRefPubMed
Metadata
Title
Winter excess mortality in intensive care in the UK: an analysis of outcome adjusted for patient case mix and unit workload
Authors
David A. Harrison
Panuwat Lertsithichai
Anthony R. Brady
James R. Carpenter
Kathy Rowan
Publication date
01-10-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 10/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2390-6

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