Abstract
IntroductionThe relationship between admission time and intensive care unit (ICU) mortality is inconclusive and influenced by various factors. This study aims to estimate the effect of admission time on ICU outcomes in a tertiary teaching hospital in China by propensity score matching (PSM) and stratified analysis.MethodsA total of 2,891 consecutive patients were enrolled in this study from 1 January 2009 to 29 December 2011. Multivariate logistic regression and survival analysis were performed in this retrospective study. PSM and stratified analysis were applied for confounding factors, such as Acute Physiology and Chronic Health Evaluation II (APACHE II) score and admission types.ResultsCompared with office hour subgroup (n = 2,716), nighttime (NT, n = 175) subgroup had higher APACHE II scores (14 vs. 8, P < 0.001), prolonged length of stay in the ICU (42 vs. 24 h, P = 0.011), and higher percentages of medical (8.6% vs. 3.3%, P < 0.001) and emergency (59.4% vs. 12.2%, P < 0.001) patients. Moreover, NT admissions were related to higher ICU mortality [odds ratio (OR), 1.725 (95% CI 1.118–2.744), P = 0.01] and elevated mortality risk at 28 days [14.3% vs. 3.2%; OR, 1.920 (95% CI 1.171–3.150), P = 0.01]. PSM showed that admission time remained related to ICU outcome (P = 0.045) and mortality risk at 28 days [OR, 2.187 (95% CI 1.119–4.271), P = 0.022]. However, no mortality difference was found between weekend and workday admissions (P = 0.849), even if weekend admissions were more related to higher APACHE II scores compared with workday admissions.ConclusionsNT admission was associated with poor ICU outcomes. This finding may be related to shortage of onsite intensivists and qualified residents during NT. The current staffing model and training system should be improved in the future.
Highlights
The relationship between admission time and intensive care unit (ICU) mortality is inconclusive and influenced by various factors
We assessed whether APACHE Acute Physiology and Chronic Health Evaluation II (II) score influenced the correlation between NT admission and Length of stay in the ICU (LOSICU)
The results showed that NT admission was associated with prolonged LOSICU, regardless of APACHE II score subgroup (median high APACHE II score subgroup: 119 hours in NT vs. 90 hours in office hours (OH) (P < 0.001), median low APACHE II score subgroup: 48 hours in NT vs. 38 hours in OH (P = 0.008))
Summary
The relationship between admission time and intensive care unit (ICU) mortality is inconclusive and influenced by various factors. Some studies showed an increased ratio of deaths among patients admitted during NT [5,6,7], whereas others documented a no-risk effect [8,9,10,11,12], or even a surprisingly protective effect [13,14], of NT admission relative to mortality. These studies were performed in Western countries where critical care medicine (CCM) is well-developed. This documentation is not available in developing countries with limited healthcare resources [15]
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