Higher Intensive Care Unit Admission Research Articles

Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia.

Among patients whose need for intensive care is uncertain, the relationship of intensive care unit (ICU) admission with mortality and costs is unknown. To estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. Retrospective cohort study of Medicare beneficiaries (aged >64 years) admitted to 2988 acute care hospitals in the United States with pneumonia from 2010 to 2012. ICU admission vs general ward admission. Primary outcome was 30-day all-cause mortality. Secondary outcomes included Medicare spending and hospital costs. Patient and hospital characteristics were adjusted to account for differences between patients with and without ICU admission. To account for unmeasured confounding, an instrumental variable was used-the differential distance to a hospital with high ICU admission (defined as any hospital in the upper 2 quintiles of ICU use). Among 1,112,394 Medicare beneficiaries with pneumonia, 328,404 (30%) were admitted to the ICU. In unadjusted analyses, patients admitted to the ICU had significantly higher 30-day mortality, Medicare spending, and hospital costs than patients admitted to a general hospital ward. Patients (n = 553,597) living closer than the median differential distance (<3.3 miles) to a hospital with high ICU admission were significantly more likely to be admitted to the ICU than patients living farther away (n = 558,797) (36% for patients living closer vs 23% for patients living farther, P < .001). In adjusted analyses, for the 13% of patients whose ICU admission decision appeared to be discretionary (dependent only on distance), ICU admission was associated with a significantly lower adjusted 30-day mortality (14.8% for ICU admission vs 20.5% for general ward admission, P = .02; absolute decrease, -5.7% [95% CI, -10.6%, -0.9%]), yet there were no significant differences in Medicare spending or hospital costs for the hospitalization. Among Medicare beneficiaries hospitalized with pneumonia, ICU admission of patients for whom the decision appeared to be discretionary was associated with improved survival and no significant difference in costs. A randomized trial may be warranted to assess whether more liberal ICU admission policies improve mortality for patients with pneumonia.

Correlation of computed tomographic signs of hypoperfusion and clinical hypoperfusion in adult blunt trauma patients.

The computed tomographic signs of hypoperfusion (CTSHs) have been reported in radiology literature as preceding the onset of clinical shock in children, but its correlation with tenuous hemodynamic status in adult blunt trauma patients has not been well studied. We hypothesized that these CT findings represent a clinically hypoperfused state and predict patient outcomes. We retrospectively reviewed 52 adult blunt trauma patients who presented to our Level I trauma center with an Injury Severity Score (ISS) greater than 15 and a systolic blood pressure less than 90 mm Hg and who underwent torso CT scans during a period of 5.5 years. Patient's demographics and clinical data were recorded. All CT scans were assessed by our radiologist (J.M.) for 25 CTSHs. Seventy-nine percent of the patients studied exhibited CTSH. The mean number of signs identified per patient was 4. Patient with the most common CTSH, that is, free peritoneal fluid, small bowel enhancement, flattened inferior vena cava (IVC), and flattened renal veins, had a significantly higher intensive care unit admission rate than those without (all p < 0.05). Patient with signs of small bowel abnormal enhancement/dilation, flattened IVC/renal vein had worse acidosis (all p < 0.05). A significantly lower admission hemoglobin and an increased need for red blood cell transfusion were found in patient with flattened IVC (p < 0.05), flattened renal vein (p < 0.01), and active contrast extravasation (p < 0.01). Univariate analysis identified small bowel dilatation and splenic injury as factors associated with mortality and laparotomy, respectively. Logistic regression model revealed that splenic injury is a significant independent predictor of laparotomy (odd ratio, 7.50; 95% confidence interval, 1.67-33.71; p < 0.01). CTSH correlates with clinical hypoperfusion in blunt trauma patients and has important prognostic and therapeutic implications. The presence of CTSH in blunt trauma patients should draw immediate attention and require prompt intervention. Trauma surgeons should be familiar with these signs and include them in the clinical decision-making paradigms to improve outcomes in blunt trauma. Diagnostic study, level III.

Outcome of cancer patients admitted through the emergency department (ED) of a comprehensive cancer center: A call for ED-based palliative care.

194 Background: The National Cancer Policy Forum advocated for improving quality of end life care, and reducing cost for cancer patients. Identifying those at high risk for Intensive Care Unit (ICU) admission, and hospital death may allow earlier palliative care and avoid futile interventions. The purpose of this study is to examine risk factors for ICU admission, and hospital death among cancer patients admitted through the emergency department (ED). Methods: We queried MD Anderson Cancer Center databases for all patients who visited our ED in 2010. ICU admission and hospital deaths of these patients were reviewed, and individual patients’ data were analyzed. Results: In 2010, 16,038 ED visits were made by 9,246 unique cancer patients. Of these patients, 5,362 (58%) were admitted to the hospital at least once (range 1-13 admits). Of all patients admitted through the ED, 697 (13%) were admitted at least once to ICU. Of all patients admitted, 11% died during hospitalization; of those, 29% died in ICU. Among patients who died in ICU, 73/233 (31.3%) had hematologic malignancies and 96/354 (27.1%) had solid tumors (P&lt;0.001). Patients admitted to ICU had median lengths of hospital stay (MLOS) of 13 days for hematologic and 8 days for solid tumors (P&lt;0.001; using means); patients without ICU admission had MLOS of 6 and 5 days, respectively (P&lt;0.001). In a multivariate logistic regression model for predicting in-hospital mortality, we found that ED presenting symptoms of respiratory distress or altered mental status; primary tumor of lung cancer, leukemia, unknown primary, or lymphoma; and nonwhite ethnicities were independent predictors of death. Insignificant factors included age, gender, residence, fever and pain. Conclusions: Cancer patients admitted through the ED experience high ICU admission rate, and hospital mortality. Lung and certain other cancers; race; and symptoms of respiratory distress and altered mental status were associated with increased risk of in-hospital death. Patients with these risk factors may benefit from efforts to improve palliative care and prevent futile interventions.

High Intensive Care Unit Admission Rate for 2013–2014 Influenza Is Associated with a Low Rate of Vaccination

High Intensive Care Unit Admission Rate for 2013–2014 Influenza Is Associated with a Low Rate of Vaccination

Anterior abdominal stab injury: a comparison of self-inflicted and intentional third-party stabbings

BackgroundThere is minimal literature comparing self-inflicted (SI) with non–self-inflicted (NSI) anterior abdominal stab wounds (AASW). MethodsAdult patients treated at a level 1 trauma center from 2006 through 2011 with an AASW were reviewed. ResultsThere were 215 patients with an AASW; 20% were SI. NSI patients had more nonabdominal injuries (47% vs 16%, P < .01) and disposition directly to the operating room (45% vs 26%, P = .02). Intra-abdominal injury rates were similar. One hundred twenty-eight patients had isolated AASWs; 28% were SI. SI patients had higher admission rates (86% vs 63%, P = .01). One hundred three patients had isolated stable/asymptomatic AASWs; 31% were SI. SI patients had more admissions (84% vs 52%, P < .01), had higher intensive care unit admission rates (23% vs 5%, P = .01), longer LOS (3.2 vs 1.4, P < .01), and higher hospital charges ($18,000 vs $11,000, P < .01). The rates of intra-abdominal injury were again similar. ConclusionsControlling for extra-abdominal injuries, SI AASW patients have similar rates of intra-abdominal injury but use more resources.

Variation Exists in Rates of Admission to Intensive Care Units for Heart Failure Patients Across Hospitals in the United States

Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. We identified 166 224 HF discharges from 341 hospitals in the 2009-2010 Premier Perspective database. We excluded hospitals with <25 HF admissions, patients <18 years old, and transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (interquartile range, 6%-16%; range, 0%-88%). In top-quartile hospitals, treatments requiring an ICU were used less often; the percentage of ICU days receiving mechanical ventilation was 6% for the top quartile versus 15% for the others; noninvasive positive pressure ventilation, 8% versus 19%; vasopressors and/or inotropes, 9% versus 16%; vasodilators, 6% versus 12%; and any of these interventions, 26% versus 51%. Overall HF in-hospital risk-standardized mortality was similar (3.4% versus 3.5%; P=0.2). ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes.

The region makes the difference: disparities in management of acute myocardial infarction within Switzerland

In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the management of acute myocardial infarction (AMI). In this study, we assessed geographical differences within Switzerland regarding management of AMI. Cross-sectional study. Swiss hospital discharge database for period 2007-2008 (26,204 discharges from AMI). Seven Swiss regions (Leman, Mittelland, Northwest, Zurich, Central, Eastern, and Ticino) were analysed. Almost 53.7% of discharges from AMI were managed in a single hospital, ranging from 62.1% (Leman) to 31.6% (Ticino). The highest intensive care unit admission rate was in Leman (69.4%), the lowest (16.9%) in Ticino (Swiss average: 36.0%). Intracoronary revascularization rates were highest in Leman (51.1%) and lowest (30.9%) in Central Switzerland (average: 41.0%). Bare (non-drug-eluting) stent use was highest in Leman (61.4%) and lowest (16.9%) in Ticino (average: 42.1%), while drug-eluting stent use was highest (83.2%) in Ticino and lowest (38.6%) in Leman (average: 57.9%). Coronary artery bypass graft rates were highest (4.8%) in Ticino and lowest (0.5%) in Eastern Switzerland (average: 2.8%). Mechanical circulatory assistance rates were highest (4.2%) in Zurich and lowest (0.5%) in Ticino (average: 1.8%). The differences remained after adjusting for age, single or multiple hospital management, and gender. In Switzerland, significant geographical differences in management and revascularization procedures for AMI were found.

Minimally Invasive Thymectomy and Open Thymectomy: Outcome Analysis of 263 Patients

An open thymectomy is a morbid procedure. If a minimally invasive thymectomy is performed without compromising the tenets of thymic surgery, it has the potential for decreasing morbidity and may offer similar clinical and oncologic results. This is an institutional review board-approved, retrospective study of a single center's experience with both open (transsternal) and minimally invasive (video-assisted thoracoscopic surgery) thymectomy. Survival estimates and statistical comparisons were calculated using standard software. From 2000 to 2011, 263 patients (93 men; median age, 49 years; interquartile range, 37 to 60 years) underwent thymectomy for indications including myasthenia gravis (n=139) and mediastinal mass (n=108). Seventy-seven thymectomies were performed by minimally invasive approach. Both groups were equally stratified by sex, body mass index, World Health Organization and Masaoka-Koga staging, incidence of myasthenia gravis, and comorbidities except hyperlipidemia and diabetes. The minimally invasive thymectomy cohort had significantly shorter hospital (p<0.01) and intensive care unit lengths of stay (p<0.01) and a lower estimated blood loss (p<0.01). There was an insignificant difference in postoperative cardiac and respiratory complication rates as well as vocal cord paralysis (p=0.60). There was no difference in terms of operative room times (p=0.88) or volume of blood products transfused (p=0.16) between the two groups. Higher estimated blood loss was associated with higher intensive care unit admission rates (p<0.01). All minimally invasive thymoma resections were complete, with negative margins. Minimally invasive thymectomy is safe and achieves a comparable resection and postoperative complication profile when used selectively for all indications, including myasthenia gravis and small thymomas without vascular invasion.

Concomitant Pulmonary Tuberculosis in Hospitalized Healthcare-Associated Pneumonia in a Tuberculosis Endemic Area: A Multi-center Retrospective Study

BackgroundIn tuberculosis (TB) endemic areas, Mycobacterium tuberculosis is an important but easily misdiagnosed pathogen in community-acquired pneumonia (CAP). However, the occurrence of concomitant pulmonary tuberculosis (PTB) in hospitalized healthcare-associated pneumonia (HCAP) has never been investigated.Methods and FindingsSeven hundred and one hospitalized HCAP and 934 hospitalized CAP patients from six medical centers in Taiwan were included in this nationwide retrospective study. Concomitant PTB was defined as active PTB diagnosed within 60 days of admission due to HCAP or CAP. The predictors for concomitant PTB and the impact of PTB on the outcomes of pneumonia were investigated. Among the enrolled subjects, 21/701 (3%) of the HCAP patients and 25/934 (2.7%) of the CAP patients were documented to have concomitant PTB. In multivariate analysis, a history of previous anti-TB treatment (OR = 5.84, 95% CI: 2.29–20.37 in HCAP; OR = 3.33, 95% CI: 1.09–10.22 in CAP) and escalated pneumonia severity index (PSI) scores (OR = 1.014, 95% CI: 1.002–1.026, in HCAP; OR = 1.013, 95% CI: 1.001–1.026, in CAP) were independent predictors for concomitant PTB in both CAP and HCAP patients. Regarding treatment outcomes, HCAP patients with concomitant PTB were associated with more acute respiratory failure within 48 hours of admission (47.6% vs. 22.6%, p = 0.008), higher intensive care unit admission rate (61.9% vs. 35.7%, p = 0.014), longer hospitalization (39.6±34.1 vs. 23.7±27 days, p = 0.009), and higher in-hospital mortality (47.6% vs. 26.3%, p = 0.03) than those without concomitant PTB. Exposure to certain groups of antibiotics for the treatment of pneumonia was not associated with the occurrence of concomitant PTB.ConclusionsIn HCAP patients, the occurrence of concomitant PTB is comparable with that in CAP patients and associated with higher PSI scores, more acute respiratory failure, and higher in-hospital mortality.

Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study

BackgroundAtrial fibrillation (AF) after thoracic surgery is a continuing source of morbidity and mortality. The effect of postoperative AF on long-term survival however has not been studied. Our aim was to evaluate the impact of AF on early outcome and on survival > 5 years after pulmonary lobectomy for lung cancer.MethodsFrom 1996 to June 2009, 454 consecutive patients undergoing lobectomy for lung cancer were enrolled and followed-up until death or study end (October 2010). Patients with postoperative AF were identified; AF was investigated with reference to its predictors and to short- and long-term survival (> 5 years).ResultsHospital mortality accounted for 7 patients (1.5%), while postoperative AF occurred in 45 (9.9%). Independent AF predictors were: preoperative paroxysmal AF (odds ratio [OR] 5.91; 95%CI 2.07 to 16.88), postoperative blood transfusion (OR 3.61; 95%CI 1.67 to 7.82) and postoperative fibro-bronchoscopy (OR 3.39; 95%CI 1.48 to 7.79). Patients with AF experienced higher hospital mortality (6.7% vs. 1.0%, p = 0.024), longer hospitalization (15.3 ± 10.1 vs. 12.2 ± 5.2 days, p = 0.001) and higher intensive care unit admission rate (13.3% vs. 3.9%, p = 0.015). The median follow-up was 36 months (maximum: 179 months). Among the 445 discharged subjects with complete follow-up, postoperative AF was not an independent predictor of mortality; however, among the 151 5-year survivors, postoperative AF independently predicted poorer long-term survival (HR 3.75; 95%CI 1.44 to 9.08).ConclusionAF after pulmonary lobectomy for lung cancer, in addition to causing higher hospital morbidity and mortality, predicts poorer long-term outcome in 5-year survivors.

Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen

ObjectivesTo review the need for operative intervention and critical care services for motocross truncal injuries in children.Design cohortRetrospective review of patients identified via the hospital trauma registry.SettingOur Level 1 Pediatric...

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

Hypoxemia may influence the prognosis of patients with mild pneumonia, regardless of the initial CURB-65 score (confusion, blood urea nitrogen > 20 mg/dL, respiratory rate > 30 breaths/min, blood pressure < 90/60 mm Hg, and age ≥ 65 y). To determine the risk factors associated with hypoxemia and the influence of hypoxemia on clinical outcomes in hospitalized patients with mild pneumonia. We performed a multicenter prospective cohort study of 585 consecutive hospitalized patients with mild pneumonia (CURB-65 groups 0 and 1). We stratified the patients according to the presence of hypoxemia, defined as a P(aO(2))/F(IO(2)) < 300 mm Hg on admission. We assessed the risk factors associated with hypoxemia, hypoxemia's influence on the course of pneumonia, and clinical outcomes (mortality, hospital stay, and need for intensive care unit admission), with multivariable regression. Fifty percent of the patients (294 cases) had hypoxemia on admission. The risk factors independently associated with hypoxemia were: bilateral radiological involvement (odds ratio 2.8, 95% CI 1.1-7.5), history of COPD (odds ratio 2.5, 95% CI 1.4-4.3), and hypoalbuminemia (odds ratio 2.0, 95% CI 1.1-3.5). The hypoxemic patients had longer hospital stay, higher intensive care unit admission rate, higher rate of severe sepsis, and higher mortality than the non-hypoxemic patients. Hypoxemia in patients with mild pneumonia is independently associated with several adverse clinical and radiological variables, and the hypoxemic patients had worse clinical outcomes than the non-hypoxemic patients. Therefore, additional attention should be paid to the presence of hypoxemia, regardless of a low CURB-65 score.

Outcomes After Pediatric Ureteral Reimplantation: A Population Based Analysis

Pediatric urology literature is often biased toward single, high volume institutions. We determined the impact of patient, surgeon and hospital characteristics on immediate outcomes for children undergoing ureteral reimplantation. We queried the University Health-System Consortium Clinical Data Base to identify a pediatric population who underwent ureteroneocystostomy between 2004 and 2009. We measured the association of the outcome variables length of stay, number of days in the intensive care unit and complication rates on the independent variables of age, gender, race, insurance status, year of surgery, and surgeon and hospital characteristics. The data were analyzed using multiple logistic, Poisson and Poisson hurdle model regression analyses incorporating random effects for surgeon and hospital. We identified 5,668 subjects who underwent ureteroneocystostomy. Compared with patients treated by high volume providers, those treated by low volume surgeons (less than 13 cases per year) had a longer length of stay (47%), higher odds of intensive care unit admission (OR 8.1), longer intensive care unit stays (103%) and higher rate of surgical related complications (162%). Other independent variables of male gender, nonwhite race and prior comorbidities were independently associated with longer length of stay, higher intensive care unit admissions and higher risk of complications. Surgeon volume, not hospital volume, is an important and consistent predictor of length of stay, intensive care unit admissions, intensive care unit days and complication rate after ureteroneocystostomy. These findings posit that the short length of stay, low intensive care unit admission rate and low complication rate reported in the literature may not be generalizable, but rather limited to higher volume surgeons.

Hospital preparedness and clinical description of the 2009 influenza A (H1N1) pandemic in a Belgian tertiary hospital

We describe hospital preparedness, including costs, and clinical characteristics of the 2009 influenza A (H1N1) pandemic in adult patients in a Belgian tertiary care centre. A task force coordinated the overall management, including triage and hospitalisation. Between 1 June and 30 November 2009, 521 patients with influenza-like illness were admitted to the emergency ward. We reviewed data from 43 hospitalised patients with confirmed influenza A. Median age was 44 years (range: 21-79), with 84% patients having underlying disease. Eleven needed admission to intensive care unit (ICU) and one patient died. The financial impact of the epidemic was estimated at €75,691, and approximately half of these costs were related to the enhanced infection control practices. The Belgian 2009 influenza A (H1N1) pandemic, as described in a cohort of 43 hospitalised patients, was associated with a relatively high ICU admission rate of 26% and a fairly typical mortality rate of 3%. This retrospective study may help us refine the management of future epidemics.

Lung abscess predicts the surgical outcome in patients with pleural empyema

ObjectivesMost cases of pleural empyema are caused by pulmonary infections, which are usually combined with pneumonia or lung abscess. The mortality of patients with pleural empyema remains high (up to 20%). It also contributes to higher hospital costs and longer hospital stays. We studied pleural empyema with combined lung abscess to determine if abscess was associated with mortality.MethodsFrom January 2004 to December 2006, we retrospectively reviewed 259 patients diagnosed with pleural empyema who received thoracscopic decortications of the pleura in a single medical center. We evaluated their clinical data and analyzed their chest computed tomography scans. Outcomes of pleural empyema were compared between groups with and without lung abscess.ResultsTwenty-two pleural empyema patients had lung abscesses. Clinical data showed significantly higher incidences in the lung abscess group of pre-operative leukocytosis, need for an intensive care unit stay and mortality.ConclusionPatients with pleural empyema and lung abscess have higher intensive care unit admission rate, higher mortality during 30 days and overall mortality than patients with pleural empyema. The odds ratio of lung abscess is 4.685. Physician shall pay more attention on high risk patient of lung abscess for early detection and management.

Maternal and Neonatal Outcomes of Repeat Cesarean Delivery in Women with a Prior Classical versus Low Transverse Uterine Incision

We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD. Of the 7936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; P < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, odds ratio 9.35, 95% confidence interval 1.76 to 31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD.

Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital

Objective To evaluate a two-tiered trauma activation protocol in a major trauma referral hospital in Australia. Methods A prospective study performed over a 12-month period of all consecutive trauma activations in a major trauma referral hospital. The triage tool assigned patients into two tiers of trauma activation. The full trauma activation was initiated where physiological or anatomical criteria were present. These patients were assessed by a multispecialty trauma team. A consult trauma activation was initiated where only mechanism of injury criteria was present. These patients were assessed by the Emergency Department Registrar and Surgical Registrar. The primary endpoint was major trauma outcome defined as either injury severity score (ISS) greater than 15, requirement for High Dependency Unit or Intensive Care Unit (HDU/ICU) admission, need for urgent operative intervention, or in hospital mortality. Results Of 1144 trauma activations, 468 (41%) were full trauma and 676 (59%) were consult trauma activations. The full trauma activation group had a significantly higher proportion of the major trauma outcome (34% vs. 5%, p < 0.01) and all 18 patients (2%) who died were in the full trauma activation group. Sensitivity of the triage tool for the major trauma outcome was 83%, specificity was 68%, undertriage was 3% and overtriage was 27%. Conclusions The two-tiered trauma activation protocol is effective in identifying patients with major trauma from those with minor trauma. There were no deaths in undertriaged patients.

Transthoracic Ultrasonography in Predicting the Outcome of Small-Bore Catheter Drainage in Empyemas or Complicated Parapneumonic Effusions

Thoracic sonography has been advocated as being complementary to small-bore catheter drainage in pleural effusions. However, it is not known whether the initial sonographic appearances of empyemas or complicated parapneumonic effusions (CPPEs) can predict the outcomes of small-bore catheter drainage for these pleural insults. This retrospective study investigated the outcomes of patients who had been diagnosed with empyema and CPPE and had received ultrasound-guided small-bore catheter (size from 12F to 16F) drainage in a tertiary university hospital from September 2005 to August 2007. Patients were excluded when empyemas or CPPEs were traumatic, they were less than 18 years old or their charts were incomplete. We evaluated 141 small-bore catheters in 70 patients with empyemas and 71 patients with CPPEs over a two-year period. The mean age was 58 ± 15 y and the male gender was more frequent (112 men, 79%). The overall successful rate of small-bore catheter drainage in empyemas or CPPEs was 63% (89/141). The sonographic appearances of these empyemas or CPPEs exhibited a complex septated pattern in 57% (81/141) of patients and a complex nonseptated pattern in 43% (60/141) of patients. The success rate in a complex nonseptated sonographic pattern was significantly higher than in a complex septated sonographic pattern (48/60, 80% vs. 41/81, 51%, respectively; p = 0.001). Moreover, patients with complex septated sonographic patterns also had higher intensive care unit admission rates compared with nonseptated sonographic patterns (22/81, 27%, vs. 8/60, 13%, respectively; p = 0.0047), as well as infection-related mortality rates (17/81, 21% vs. 4/60, 7%, respectively; p = 0.018). The appearance of sonographic septation is a useful sign to help predict the outcome of small-bore catheter drainage in cases of empyemas or CPPEs. Patients with a complex septated sonographic pattern have a poorer prognosis for a successful outcome, higher ICU admission rate and a higher mortality rate.