Abstract
Delayed admission of patients to the intensive care unit (ICU) is increasing worldwide and can be followed by adverse outcomes when critical care treatment is not provided timely. This systematic review and meta-analysis appraised and synthesized the published literature about the association between delayed ICU admission and mortality of adult patients. Articles published from inception up to August 2021 in English-language, peer-reviewed journals indexed in CINAHL, PubMed, Scopus, Cochrane Library, and Web of Science were searched by using key terms. Delayed ICU admission constituted the intervention, while mortality for any predefined time period was the outcome. Risk for bias was evaluated with the Newcastle-Ottawa Scale and additional criteria. Study findings were synthesized qualitatively, while the odds ratios (ORs) for mortality with 95% confidence intervals (CIs) were combined quantitatively. Thirty-four observational studies met inclusion criteria. Risk for bias was low in most studies. Unadjusted mortality was reported in 33 studies and was significantly higher in the delayed ICU admission group in 23 studies. Adjusted mortality was reported in 18 studies, and delayed ICU admission was independently associated with significantly higher mortality in 13 studies. Overall, pooled OR for mortality in case of delayed ICU admission was 1.61 (95% CI 1.44-1.81). Interstudy heterogeneity was high (I2 = 66.96%). According to subgroup analysis, OR for mortality was remarkably higher in postoperative patients (OR, 2.44, 95% CI 1.49-4.01). These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non-ICU settings.
Highlights
Τhe concept of delayed admission of patients to the intensive care unit (ICU) has attracted international research interest, due to its increasing incidence and its presumed negative impact on patient outcomes [1, 2]
These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non-ICU settings
Delayed ICU admission was found to be associated with significantly higher mortality of adult patients considered to need critical care
Summary
Τhe concept of delayed admission of patients to the intensive care unit (ICU) has attracted international research interest, due to its increasing incidence and its presumed negative impact on patient outcomes [1, 2]. NonICU settings commonly used for boarding (that is, waiting until ICU admission) critically ill patients, such as the emergency department (ED) and the postanesthesia care unit (PACU), are not appropriately designed and equipped, while their staff is neither sufficiently trained nor experienced in BioMed Research International providing critical care [13, 14]. In this context, delays in the provision of disease-specific protocolized care, including fluid and antibiotic administration, have been reported for critically ill patients boarded in the ED [15, 16]
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