Swedish Intensive Care Registry Research Articles

Factors and health-related quality of life associated with participation in a post-ICU follow-up. A register study.

Follow-up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse-led clinic (NLC) at different time-points, and to describe physical and mental health (HRQoL) over time. Patients with a length of stay (LOS) of ≥72hours, discharged from a general intensive care unit 2004-2014, who participated in a 6-month follow-up programme offering visits to NLC at 2 and 6months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on 2-, 6- and 12-month HRQoL by using SF-36 from the Swedish Intensive Care Registry. Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P=.000), had lower Simplified Acute Physiology scores (P=.001) and higher SF-36 physical health domain scores at 2months (P<.05) compared to those not visiting at all. Visitors at 2months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at 6months only. Patients visiting the NLC scored significantly higher in all domains from 2 to 12months, whereas non-visiting-patients' did this in four out of eight domains during the same time frame. Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to the development of existing routines to match the diversity of patients' needs and life situations.

Long-term outcome after intensive care for COVID-19: differences between men and women\u2014a nationwide cohort study

BackgroundQuestions remain about long-term outcome for COVID-19 patients in general, and differences between men and women in particular given the fact that men seem to suffer a more dramatic course of the disease. We therefore analysed outcome beyond 90 days in ICU patients with COVID-19, with special focus on differences between men and women.MethodsWe identified all patient ≥ 18 years with COVID-19 admitted between March 6 and June 30, 2020, in the Swedish Intensive Care Registry. Patients were followed until death or study end-point October 22, 2020. Association with patient sex and mortality, in addition to clinical variables, was estimated using Cox regression. We also performed a logistic regression model estimating factors associated with 90-day mortality.ResultsIn total, 2354 patients with COVID-19 were included. Four patients were still in the ICU at study end-point. Median follow-up time was 183 days. Mortality at 90-days was 26.9%, 23.4% in women and 28.2% in men. After 90 days until end of follow-up, only 11 deaths occurred. On multivariable Cox regression analysis, male sex (HR 1.28, 95% CI 1.06–1.54) remained significantly associated with mortality even after adjustments. Additionally, age, COPD/asthma, immune deficiency, malignancy, SAPS3 and admission month were associated with mortality. The logistic regression model of 90-day mortality showed almost identical results.ConclusionsIn this nationwide study of ICU patients with COVID-19, men were at higher risk of poor long-term outcome compared to their female counterparts. The underlying mechanisms for these differences are not fully understood and warrant further studies.

A nationwide study of the long-term prevalence of dementia and its risk factors in the Swedish intensive care cohort

BackgroundDeveloping dementia is feared by many for its detrimental effects on cognition and independence. Experimental and clinical evidence suggests that sepsis is a risk factor for the later development of dementia. We aimed to investigate whether intensive care-treated sepsis is an independent risk factor for a later diagnosis of dementia in a large cohort of intensive care unit (ICU) patients.MethodsWe identified adult patients admitted to an ICU in 2005 to 2015 and who survived without a dementia diagnosis 1 year after intensive care admission using the Swedish Intensive Care Registry, collecting data from all Swedish general ICUs. Comorbidity, the diagnosis of dementia and mortality, was retrieved from the Swedish National Patient Registry, the Swedish Dementia Registry, and the Cause of Death Registry. Sepsis during intensive care served as a covariate in an extended Cox model together with age, sex, and variables describing comorbidities and acute disease severity.ResultsOne year after ICU admission 210,334 patients were alive and without a diagnosis of dementia; of these, 16,115 (7.7%) had a diagnosis of sepsis during intensive care. The median age of the cohort was 61 years (interquartile range, IQR 43–72). The patients were followed for up to 11 years (median 3.9 years, IQR 1.7–6.6). During the follow-up, 6312 (3%) patients were diagnosed with dementia. Dementia was more common in individuals diagnosed with sepsis during their ICU stay (log-rank p < 0.001), however diagnosis of sepsis during critical care was not an independent risk factor for a later dementia diagnosis in an extended Cox model: hazard ratio (HR) 1.01 (95% confidence interval 0.91–1.11, p = 0.873). Renal replacement therapy and ventilator therapy during the ICU stay were protective. High age was a strong risk factor for later dementia, as was increasing severity of acute illness, although to a lesser extent. However, the severity of comorbidities and the length of ICU and hospital stay were not independent risk factors in the model.ConclusionAlthough dementia is more common among patients treated with sepsis in the ICU, sepsis was not an independent risk factor for later dementia in the Swedish national critical care cohort.Trial registrationThis study was registered a priori with the Australian and New Zeeland Clinical Trials Registry (registration no. ACTRN12618000533291).

Prevalence and Intensive Care Bed Use in Subjects on Prolonged Mechanical Ventilation in Swedish ICUs.

The number of patients requiring prolonged mechanical ventilation (PMV) is predicted to escalate due to an aging population. International studies on prevalence and resource utilization of this patient group exist, but data are lacking from Scandinavian ICUs, where there is a relatively low number of ICU beds in relation to population. The primary aim was to identify prevalence of admissions requiring mechanical ventilation ≥ 7-21 d and PMV > 21 d, and their use of ICU bed days in Sweden. Secondary aims were to describe patient characteristics and outcomes. We obtained data from the Swedish Intensive Care Registry on admissions age ≥ 18 y mechanically ventilated ≥ 7 d and used open source registry data to calculate the prevalence and use of bed days of admissions ventilated ≥ 7-21 d and PMV > 21 d. Of the 39,510 ICU admissions to Swedish ICUs in 2017, those mechanically ventilated ≥ 7-21 d accounted for 1,643 (4%) admissions, and those with PMV > 21 d accounted for 307 (0.8%) admissions. Of the 109,457 ICU bed days, 22% were consumed by admissions ventilated ≥ 7-21 d and 10% by those with PMV > 21 d. The ICU mortality of both groups was 21%. Admissions with mechanical ventilation ≥ 7 d had a median age of 65 y and were predominantly male (64%). Admissions to Swedish ICUs who required mechanical ventilation ≥ 7-21 d and PMV > 21 d form a relatively small proportion of all ICU admissions, but consume a significant proportion of ICU beds days. Prevalence of admissions, ICU bed days, and ICU mortality were lower than reports from other countries, but the admissions were predominantly elderly and male, in accordance with other reports.

Sepsis is underreported in Swedish intensive care units: A retrospective observational multicentre study.

Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis-3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported. Adult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis-3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry. Of 5990 adult ICU patients, 28% fulfilled the Sepsis-3 criteria on admission, but only 31% of them had sepsis as the registered main diagnosis at ICU discharge. Of the 1654 Sepsis-3 patients, 38% met the septic shock criteria. The Sepsis-3 in-hospital mortality was 26% compared to 33% in patients with septic shock. The incidence rate for ICU-treated sepsis was 81 cases per 100000 person-years. One in four had a positive blood culture, and 44% were culture negative. This large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis-3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes.

Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden.

The Public Health Agency of Sweden has analyzed how many pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection have been treated in intensive care units (ICU) in Sweden between 19 March and 20 April 2020 compared with non‐pregnant women of similar age. Cases were identified in a special reporting module within the Swedish Intensive Care Registry (SIR). Fifty‐three women aged 20‐45 years with SARS‐CoV‐2 were reported in SIR, and 13 of these women were either pregnant or postpartum (<1 week). The results indicate that the risk of being admitted to ICU may be higher in pregnant and postpartum women with laboratory‐confirmed SARS‐CoV‐2 in Sweden, compared with non‐pregnant women of similar age.

Causes of late mortality among ICU-treated patients with sepsis.

Patients with sepsis may have an increased risk of late mortality, but the causes of late death are unclear. This retrospective matched cohort study aimed to determine the causes of late death (≥1year) among patients with sepsis compared to patients without sepsis. 8760 patients with severe sepsis or septic shock (2001 consensus criteria) registered in the Swedish Intensive Care Registry (2008-2013) were compared with a 1:1 matched (gender, age, SAPS3 probability for death, ICU length of stay) control group consisting of non-septic ICU patients. Causes of death (International Classification of Diseases codes) were obtained from the Swedish Cause of Death Register (2008-2014). During 2008-2014, 903 patients with sepsis died at≥365days after their initial septic event, compared to 884 patients in the control group. Median time of follow-up was 313days (sepsis group, interquartile range 11-838days) vs 288days (control group, 9-836days). The most common causes of death were heart diseases (sepsis: 50.2%, non-septic: 48.6%) and cancer (sepsis: 33.7%, non-septic: 31.7%). Infectious diseases were significantly more common cause of death in the sepsis group (24.3% vs 19.6%, respectively; P<.05). Pneumonia was a common infectious cause of death in both groups, whereas sepsis was more common in the sepsis group. The most common causes of late death after ICU admission among patients with and without sepsis were heart diseases and cancer. However, patients with sepsis more frequently had infectious diseases as a cause of late death, compared to non-septic patients.

Mortality Prediction After Cardiac Surgery: Higgins’ Intensive Care Unit Admission Score Revisited

This study was performed to develop and validate a cardiac surgical intensive care risk adjustment model for mixed cardiac surgery based on a few preoperative laboratory tests, extracorporeal circulation time, and measurements at arrival to the intensive care unit. This was a retrospective study of admissions to 5 cardiac surgical intensive care units in Sweden that submitted data to the Swedish Intensive Care Registry. Admissions from 2008 to 2014 (n= 21,450) were used for model development, whereas admissions from 2015 to 2016 (n= 6463) were used for validation. Models were built using logistic regression with transformation of raw values or categorization into groups. The final model showed good performance, with an area under the receiver operating characteristics curve of 0.86 (95% confidence interval, 0.83-0.89), a Cox calibration intercept of -0.16 (95% confidence interval, -0.47 to 0.19), and a slope of 1.01 (95% confidence interval, 0.89-1.13) in the validation cohort. Eleven variables available on admission to the intensive care unit can be used to predict 30-day mortality after cardiac surgery. The model performance was better than those of general intensive care risk adjustment models used in cardiac surgical intensive care and also avoided the subjective assessment of the cause of admission. The standardized mortality ratio improves over time in Swedish cardiac surgical intensive care.

Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study

PurposeTo compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU.MethodsWe used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015.ResultsPatients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded—54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen—40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles in 41.5% of cases compared to 30.0% in women (p < 0.001), and shorter time to antibiotics—65 (IQR 30–136) vs 87 min (IQR 39–172) (p = 0.0001). There was no significant difference between men and women regarding ICU nursing workload, mechanical ventilation or ICU length of stay. In severity-adjusted multivariable analysis, OR for women achieving a completed sepsis bundle, compared to men was 0.64 (CI 0.51–0.81). Thirty-day mortality was 25.0% for women and 23.1% for men (p = 0.24). Adjusted OR for female death was 1.28 (CI 1.00–1.64), but the increased mortality was not mediated by differential bundle completion.ConclusionsWomen and men with severe sepsis or septic shock received differential care in the ED, but this did not explain higher odds of death in women.

Long-term survival in out-of-hospital cardiac arrest patients treated with targeted temperature control at 33 °C or 36 °C: A national registry study

AimThere are limited data on long-term outcome in out-of-hospital cardiac arrest patients following the treatment shift of target temperature management (TTM) from 33 °C to 36 °C outside the controlled settings of randomised trials. The aim of this study was to evaluate the adherence to TTM guidelines after the publication of the TTM trial and if the change in temperature level influence six-month survival. MethodsOHCA patients admitted to intensive care units (ICU) and recorded in the Swedish Intensive Care Registry (January 2010–March 2016) were included. Each ICU in Sweden provided information on their TTM target (i.e. 33 °C [TTM33] or 36 °C [TTM36]) used and the date of shift to 36 °C. The primary outcome was six-months survival. Multivariate logistic regression and propensity score match was used to adjust for confounders. ResultsIn total, 2899 OHCA patients from 69 ICUs were assessed; of those, 1038 patients were treated with TTM (TTM33, n = 755 and TTM36, n = 283). Patients receiving any TTM decreased during the study period from 70.5% to 54.5% (p for trend <0.001). There was no significant difference in six-month survival between the TTM33 (47.2%) and the TTM36 (47.3%) groups (adjusted OR 1.12 [0.80–1.56]. In the propensity score matched analysis the six-months survival was 52.7 vs 47.3 %, OR 1.29 [0.90–1.85]). ConclusionsThe proportion of patients receiving therapeutic hypothermia in Sweden has decreased significantly since the publication of the TTM-trial indicating lower adherence to guidelines. This was not associated with any significant difference in long term outcome.

Experiences of suffering multiple trauma: A qualitative study

ObjectivesIn an effort to strengthen health care professionals’ ability to anticipate and address multiple trauma patients’ needs, this study aims to explore the experience of suffering from multiple trauma. DesignThis is a qualitative descriptive study. Nine interviews were analysed using content analysis. SettingThe study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma. FindingsThe analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with ‘dead ends’ during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care. ConclusionsA shared understanding is essential in order to define a person’s needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients’ needs and address them with supportive guidance.

Age, SAPS 3 and female sex are associated with decisions to withdraw or withhold intensive care.

Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care. Registry study using data from the Swedish Intensive Care Registry (SIR) 2014-2016. Age, condition at admission, including co-morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group. Of all 97095 cases, 47.1% were 61-80 years old, 41.9% were women and 58.1% men. 14996 (15.4%) were allocated to the WW group and 82149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P < 0.001), had higher SAPS 3 (P < 0.001) and were predominantly female (P < 0.001). Compared to patients 16-20 years old, patients >81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084-1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13- 1.23). Older age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care.

A national survey on routines regarding sedation in Swedish intensive care units

Background: Previous studies concerning sedation in Swedish intensive care units (ICU) have shown variability in drug choices and strategies. Currently, there are no national guidelines on this topic. As an update to a Nordic survey from 2004, and as a follow-up to a recently introduced quality indicator from the Swedish Intensive Care Registry, we performed a national survey.Methods: A digital survey was sent to the ICUs in Sweden, asking for sedation routines regarding hypnosedatives, analgosedatives, protocols, sedation scales, etc.Results: Fifty out of 80 ICUs responded to the survey. All units used sedation scales, and 88% used the RASS scale; 80% used written guidelines for sedation. Propofol and dexmedetomidine were the preferred short-term hypnosedatives. Propofol, dexmedetomidine, and midazolam were preferred for long-term hypnosedation. Remifentanil, morphine, and fentanyl were the most frequently used agents for analgosedation.Conclusions: All ICUs used a sedation scale, an increase compared with previous studies. Concerning the choice of hypno- and analgosedatives, the use of dexmedetomidine, clonidine, and remifentanil has increased, and the use of benzodiazepines has decreased since the Nordic survey in 2004.

Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.

This study described the basic characteristics of children aged 0-16years who were treated in intensive care units (ICUs) and paediatric ICUs (PICUs), compared their outcomes and examined any causes of death. This was a retrospective cohort study of admissions to 74 ICUs and three PICUs in Sweden that were recorded in the Swedish Intensive Care Registry from January 1, 2008 to December 31, 2012. We retrieved data on 12756 children who were admitted 17003 times. The case mix differed between the ICUs, which were mainly admissions for injuries, accidents and observation, and PICUs, which were mainly admissions for malformations, genetic abnormalities and respiratory problems (p<0.001). The median stays in the ICUs and PICUs were 1.4 and 3.5days (p<0.001), respectively. The respective crude mortality rates were 1.1% and 2.0, and the Paediatric Index of Mortality version 2 standardised mortality ratios were 0.43 and 0.50. None of these differences were significant. Most deaths were within 24hours: About 57% in the ICUs, mainly from brain anomalies, and 13% in the PICUs, mainly from circulatory problems. Sweden had a low mortality rate in both ICUs and PICUs and the children admitted to these two types of unit differed.

No association with cardiac death after sepsis: A nationwide observational cohort study.

Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences and implications for patients remain unclear. The aim of this study was to investigate cardiac outcome in sepsis by assessing causes of death up to 2years after treatment in an Intensive Care Unit (ICU) in a nationwide register-based cohort collected from the Swedish Intensive Care Registry. A cohort of 13669 sepsis and septic shock ICU patients from 2008 to 2014 was collected together with a non-septic control group, matched regarding age, sex and severity of illness (n=6582), and all without preceding severe cardiac disease. For a large proportion of the severe sepsis and septic shock patients (n=7087), no matches were found. Information on causes of death up to 2years after ICU admission was sought in the Swedish National Board of Health and Welfare's Cause of Death Registry. Intensive Care Unit mortality was nearly identical in a matched comparison of sepsis patients to controls (24% in both groups) but higher in more severely ill sepsis patients for whom no matches were found (33% vs 24%, P<0.001). There was no association of sepsis to cardiac deaths in the first month (OR 1.03, 95%CI 0.87 to 1.20, P=0.76) nor up to 2years after ICU admission (OR 1.01, 95%CI 0.82 to 1.25, P=0.94) in an adjusted between-group comparison. There was no association with an increased risk of death related to cardiac disease in patients with severe sepsis or septic shock when compared to other ICU patients with similar severity of illness.

Reducing night-time discharge from intensive care. A nationwide improvement project with public display of ICU outcomes

PurposeDischarge from an intensive care unit (ICU) during the night is an independent risk factor for adverse outcomes. A quality improvement project was conducted with the aim of reducing the incidence and the associated mortality after night-time discharge. Materials and methodsICUs that submitted data to the Swedish Intensive Care Registry (SIR) agreed to appoint night-time discharge as a national quality indicator with detailed public display on the internet of various discharge proportions and outcomes. The registry was then examined for trends during a 10-year period with use of multilevel mixed-effects models. ResultsWe analysed 163,371 patients who were discharged alive from 70 ICUs to a general ward within the same hospital during 2006–2015. The prevalence of night-time discharge fell from 7.0% (95% CI: 5.2 to 8.7%) in 2006 to 4.9% (95% CI: 4.3 to 5.5%) in 2015 (P = .035 for trend). The original increased risk of death within 30 days after night-time discharge in 2006–2010, OR 1.20 (95% CI: 1.01 to 1.42), disappeared in 2011–2015, OR 1.06 (95% CI: 0.96 to 1.17). ConclusionsDuring the 10-year period of the quality improvement project, the annual prevalence and risk of death within 30-days after night-time discharge were reduced. The public display and feedback of audit data could have helped in achieving this.

Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome

Objective The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era. Methods All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as ≥ 48 h during the primary hospital stay. Patients surviving ≥ 48 h after AAA surgery were included in the analysis. Results A total of 725 patients were identified, of whom 707 (97.5%) survived ≥ 48 h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required < 48 h of intensive care, 115 (16.3%) 2–6 days and 44 (6.2%) ≥ 7 days. The rate of prolonged ICU LOS declined considerably over time, from 41.4% of all AAA repairs in 1999 to 7.3% in 2013 (p < .001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p < .001). The 30 day survival rate was 98.2% for those with < 48 h ICU stay versus 93.0% for 2–6 days versus 81.8% for ≥ 7 days (p < .001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p < .001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups. Conclusion During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected.

Editor's Choice – Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome

The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era. All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as ≥ 48h during the primary hospital stay. Patients surviving ≥ 48h after AAA surgery were included in the analysis. A total of 725 patients were identified, of whom 707 (97.5%) survived≥48h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required<48h of intensive care, 115 (16.3%) 2-6 days and 44 (6.2%)≥7 days. The rate of prolonged ICU LOS declined considerably over time, from 41.4% of all AAA repairs in 1999 to 7.3% in 2013 (p<.001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p<.001). The 30 day survival rate was 98.2% for those with < 48h ICU stay versus 93.0% for 2-6 days versus 81.8% for ≥ 7 days (p<.001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p<.001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups. During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected.

Severe sepsis in the ICU is often missing in hospital discharge codes.

Different International Classification of Diseases (ICD)-based code abstraction strategies have been used when studying the epidemiology of severe sepsis. The aim of this study was to compare three previously used ICD code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis, in a setting of intensive care patients. All patients (≥ 18 years of age) with severe sepsis according to the ACCP/SCCM criteria registered in the Swedish Intensive Care Registry (2005-2009) were included in the study. Using the Swedish National Patient Register, we investigated whether these patients fulfilled an ICD code compilation for severe sepsis at hospital discharge. Overall, 9271 patients with severe sepsis were registered in the Swedish Intensive Care Registry. A majority of these patients (55.4%) were discharged from the hospital with ICD codes that did not correspond to any of the ICD code compilations. A minority of patients (10.3%) were discharged with ICD codes corresponding to all three code abstraction strategies applied. Overall, the proportion of patients discharged with ICD codes corresponding to the criteria of Angus et al. was 15.1%, to the criteria of Flaatten was 39.8%, and to the criteria of Martin et al. was 16.0%. A majority of patients with severe sepsis according to the ACCP/SCCM criteria were not discharged with ICD codes corresponding to the ICD code abstraction strategies; thus, the abstraction strategies did not identify the correct patients.

Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age.

IntroductionPreclinical data indicate that oestrogen appears to play a beneficial role in the pathophysiology of and recovery from critical illness. In few previous epidemiologic studies, however, have researchers analysed premenopausal women as a separate group when addressing potential gender differences in critical care outcome. Our aim was to see if women of premenopausal age have a better outcome following critical care and to investigate the association between gender and use of intensive care unit (ICU) resources.MethodsOn the basis of our analysis of 127,254 consecutive Simplified Acute Physiology Score III–scored Swedish Intensive Care Registry ICU admissions from 2008 through 2012, we determined the risk-adjusted 30-day mortality, accumulated nurse workload score and ICU length of stay. To investigate associations with sex, we used logistic regression and multivariate analyses on the entire cohort as well as on two subgroups stratified by median age for menopause (up to and including 45 years and older than 45 years) and six selected diagnostic subgroups (sepsis, multiple trauma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia and cardiac arrest).ResultsThere was no sex difference in risk-adjusted mortality for the cohort as a whole, and there was no sex difference in risk-adjusted mortality in the group 45 years of age and younger. For the group of patients older than 45 years of age, we found a reduced risk-adjusted mortality in men admitted for cardiac arrest. For the cohort as a whole, and for those admitted with multiple trauma, male sex was associated with a higher nurse workload score and a longer ICU stay.ConclusionsUsing information derived from a large multiple ICU register database, we found that premenopausal female sex was not associated with a survival advantage following intensive care in Sweden. When the data were adjusted for age and severity of illness, we found that men used more ICU resources per admission than women did.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0873-1) contains supplementary material, which is available to authorized users.