Care at a non-university hospital: an independent risk factor for mortality in ARDS?

Excerpt

Many studies over the past 20 years have found an association between receiving treatment at a university or teaching hospital and decreased hospital mortality [1‐3]. However, few studies have assessed this question specifically among critically ill patients [4]. Recently, a study by Raymondos and colleagues examined the relationship between care in a university hospital and mortality for patients with the acute respiratory distress syndrome (ARDS) [5]. The study was a sub-analysis of a prospective, observational cohort of patients with respiratory failure (Second VENTILA study) [6]. The authors found that, although the characteristics of ARDS patients were somewhat similar between hospitals, unadjusted hospital mortality was significantly higher in non-university hospitals compared with university hospitals (57.5 versus 39.3%; absolute difference of 18.2%, p = 0.012). This difference remained after adjustment for patient factors, as well as factors related to individual patient management, complications during ventilation, and hospital characteristics (odds ratio 2.89; 95% confidence interval 1.31–6.38). Furthermore, they found a 9.6% increase in hospital mortality for ventilated patients who were not diagnosed with ARDS. …