Abstract
This case series reports the functional outcomes of a prospective group of patients, thought to be at high risk for future morbidity, admitted to a rural intensive care unit (ICU) for a life-threatening illness. This prospective longitudinal observational study conducted between February and August 2009 in the Alice Springs Hospital ICU included patients considered 'high risk', as evidenced by profound physiological derangement. The participants were prospectively recruited when pre-defined criteria were met. Functional outcomes were measured by performance in the six-minute walk test, and the ability to undertake activities of daily living. Persisting morbidity was crudely measured by hospital re-admission rate. Mortality was measured at 6 months. Eighteen patients consented to take part in the study. Fourteen were Indigenous, and 14 were medical patients. Six-minute walk distance did not improve between ICU discharge and 6 months, and was significantly below that predicted. Almost all patients achieved scores consistent with full independence in basic activities of daily living. Five achieved scores consistent with independence in domestic activities of daily living. Twelve required at least one re-admission, with half the Indigenous subgroup requiring three or more re-admissions. There were four deaths, all Indigenous patients, and three were homeless.< This study demonstrates that follow up in this group at 6 months is both feasible and valuable. There is evidence of persisting morbidity, and increased mortality, particularly among Indigenous patients. Further avenues of research are suggested, including the need for a large multi-centre prospective study.
Highlights
This case series reports the functional outcomes of a prospective group of patients, thought to be at high risk for future morbidity, admitted to a rural intensive care unit (ICU) for a life-threatening illness
The service population presenting to the Alice Springs Hospital (ASH) Intensive Care Unit (ICU) is markedly different to that seen within other units across the country (Table 1), and there is a perception that many of the patients discharged from the ASH ICU, remain at increased risk of further acute episodes
These studies have predominantly been undertaken in large tertiary institutions in capital cities, and there is little data on the outcomes for rural patients. To further investigate this an exploratory pilot study was undertaken to assess the ability to identify, and the logistics to follow up patients thought to be at 'high risk' of subsequent morbidity, and to assess the tools for quantifying any persisting morbidity. In this case series we present selected data focussing on functional outcomes from this study
Summary
This case series reports the functional outcomes of a prospective group of patients, thought to be at high risk for future morbidity, admitted to a rural intensive care unit (ICU) for a life-threatening illness. The poor health of the Indigenous population has been well documented and includes higher rates of chronic co-morbid disease, which is present at a younger age[2,3], while access to and continuity of care has been demonstrated as suboptimal[3]. The service population presenting to the ASH Intensive Care Unit (ICU) is markedly different to that seen within other units across the country (Table 1), and there is a perception that many of the patients discharged from the ASH ICU, remain at increased risk of further acute episodes. It is thought that intervention/s that reduce/s morbidity and functional loss may reduce re-admissions, but there is no baseline data regarding morbidity in the post-ICU period for this group
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