Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 4 ( 2017 ) > List of Articles


Influence of admission source on the outcome of patients in an intensive care unit

Anirban Hom Choudhuri, Mitali Chakravarty

Keywords : Intensive Care Unit admission source, ICU admission score, outcome

Citation Information : Choudhuri AH, Chakravarty M. Influence of admission source on the outcome of patients in an intensive care unit. Indian J Crit Care Med 2017; 21 (4):213-217.

DOI: 10.4103/ijccm.IJCCM_7_17

License: CC BY-ND 3.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Aim of the study: The admission in the Intensive Care Unit (ICU) occurs from various sources, and the outcome depends on a complex interplay of various factors. This observational study was undertaken to describe the epidemiology and compare the differences among patients admitted in a tertiary care ICU directly from the emergency room, wards, and ICUs of other hospitals. Materials and Methods: A retrospective study was conducted on 153 consecutive patients admitted from various sources in a tertiary care ICU between July 2014 and December 2015. The primary endpoint of the study was the influence of the admission source on ICU mortality. The secondary endpoints were the comparison of the duration of mechanical ventilation, length of ICU stay, and the ICU complication rates between the groups. Results: Out of the 153 patients enrolled, the mortality of patients admitted from the ICUs of other hospital were significantly higher than the patients admitted directly from the emergency room or wards/operating rooms (60.5% vs. 48.2% vs. 31.9%; P = 0.02). The incidence of ventilator-associated lung injury was lower in the patients admitted directly from the emergency room (23.4% vs. 50% vs. 50%; P = 0.03). Multivariate logistic regression analysis revealed higher age, increased disease severity, longer duration of mechanical ventilation, and longer ICU stay as independent predictors of mortality in the patients shifted from the ICUs of other hospitals. Conclusion: The study demonstrated a higher risk of ICU mortality among patients shifted from the ICUs of other hospitals and identified the independent predictors of mortality.

PDF Share
  1. Odetola FO, Rosenberg AL, Davis MM, Clark SJ, Dechert RE, Shanley TP. Do outcomes vary according to the source of admission to the pediatric Intensive Care Unit? Pediatr Crit Care Med 2008;9:20-5.
  2. Hill AD, Vingilis E, Martin CM, Hartford K, Speechley KN. Interhospital transfer of critically ill patients: Demographic and outcomes comparison with nontransferred Intensive Care Unit patients. J Crit Care 2007;22:290-5.
  3. Duke GJ, Green JV. Outcome of critically ill patients undergoing interhospital transfer. Med J Aust 2001;174:122-5.
  4. Kerr HD, Byrd JC. Community hospital transfers to a VA medical center. JAMA 1989;262:70-3.
  5. Schiff RL, Ansell DA, Schlosser JE, Idris AH, Morrison A, Whitman S. Transfers to a public hospital. A prospective study of 467 patients. N Engl J Med 1986;314:552-7.
  6. Mackenzie PA, Smith EA, Wallace PG. Transfer of adults between Intensive Care Units in the United Kingdom: Postal survey. BMJ 1997;314:1455-6.
  7. Escarce JJ, Kelley MA. Admission source to the medical Intensive Care Unit predicts hospital death independent of APACHE II score. JAMA 1990;264:2389-94.
  8. Dragsted L, Jörgensen J, Jensen NH, Bönsing E, Jacobsen E, Knaus WA, et al. Interhospital comparisons of patient outcome from intensive care: Importance of lead-time bias. Crit Care Med 1989;17:418-22.
  9. Durairaj L, Will JG, Torner JC, Doebbeling BN. Prognostic factors for mortality following interhospital transfers to the medical Intensive Care Unit of a tertiary referral center. Crit Care Med 2003;31:1981-6.
  10. Gordon HS, Rosenthal GE. Impact of interhospital transfers on outcomes in an academic medical center. Implications for profiling hospital quality. Med Care 1996;34:295-309.
  11. Rosenberg AL, Hofer TP, Strachan C, Watts CM, Hayward RA. Accepting critically ill transfer patients: Adverse effect on a referral center's outcome and benchmark measures. Ann Intern Med 2003;138:882-90.
  12. Combes A, Luyt CE, Trouillet JL, Chastre J, Gibert C. Adverse effect on a referral Intensive Care Unit's performance of accepting patients transferred from another Intensive Care Unit. Crit Care Med 2005;33:705-10.
  13. Flabouris A, Hart GK, George C. Outcomes of patients admitted to tertiary Intensive Care Units after interhospital transfer: Comparison with patients admitted from emergency departments. Crit Care Resusc 2008;10:97-105.
  14. Golestanian E, Scruggs JE, Gangnon RE, Mak RP, Wood KE. Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center. Crit Care Med 2007;35:1470-6.
  15. Wallen E, Venkataraman ST, Grosso MJ, Kiene K, Orr RA. Intrahospital transport of critically ill pediatric patients. Crit Care Med 1995;23:1588-95.
  16. Szem JW, Hydo LJ, Fischer E, Kapur S, Klemperer J, Barie PS. High-risk intrahospital transport of critically ill patients: Safety and outcome of the necessary “road trip”. Crit Care Med 1995;23:1660-6.
  17. Hurst JM, Davis K Jr., Johnson DJ, Branson RD, Campbell RS, Branson PS. Cost and complications during in-hospital transport of critically ill patients: A prospective cohort study. J Trauma 1992;33:582-5.
  18. Gervais HW, Eberle B, Konietzke D, Hennes HJ, Dick W. Comparison of blood gases of ventilated patients during transport. Crit Care Med 1987;15:761-3.
  19. Waydhas C, Schneck G, Duswald KH. Deterioration of respiratory function after intra-hospital transport of critically ill surgical patients. Intensive Care Med 1995;21:784-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.