Outcome of cancer patients considered for intensive care unit admission in two university hospitals in the Netherlands: the danger of delayed ICU admissions and off-hour triage decisions

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dc.contributor.authorvan der Zee, Esther N.
dc.contributor.authorBenoit, Dominique D.
dc.contributor.authorHazenbroek, Marinus
dc.contributor.authorBakker, Jan
dc.contributor.authorKompanje, Erwin J. O.
dc.contributor.authorKusadasi, Nuray
dc.contributor.authorEpker, Jelle L.
dc.date.accessioned2021-08-19T15:56:59Z
dc.date.available2021-08-19T15:56:59Z
dc.date.issued2021
dc.date.updated2021-08-15T00:03:14Z
dc.description.abstractAbstract Background Very few studies assessed the association between Intensive Care Unit (ICU) triage decisions and mortality. The aim of this study was to assess whether an association could be found between 30-day mortality, and ICU admission consultation conditions and triage decisions. Methods We conducted a retrospective cohort study in two large referral university hospitals in the Netherlands. We identified all adult cancer patients for whom ICU admission was requested from 2016 to 2019. Via a multivariable logistic regression analysis, we assessed the association between 30-day mortality, and ICU admission consultation conditions and triage decisions. Results Of the 780 cancer patients for whom ICU admission was requested, 332 patients (42.6%) were considered ‘too well to benefit’ from ICU admission, 382 (49%) patients were immediately admitted to the ICU and 66 patients (8.4%) were considered ‘too sick to benefit’ according to the consulting intensivist(s). The 30-day mortality in these subgroups was 30.1%, 36.9% and 81.8%, respectively. In the patient group considered ‘too well to benefit’, 258 patients were never admitted to the ICU and 74 patients (9.5% of the overall study population, 22.3% of the patients ‘too well to benefit’) were admitted to the ICU after a second ICU admission request (delayed ICU admission). Thirty-day mortality in these groups was 25.6% and 45.9%. After adjustment for confounders, ICU consultations during off-hours (OR 1.61, 95% CI 1.09–2.38, p-value 0.02) and delayed ICU admission (OR 1.83, 95% CI 1.00–3.33, p-value 0.048 compared to “ICU admission”) were independently associated with 30-day mortality. Conclusion The ICU denial rate in our study was high (51%). Sixty percent of the ICU triage decisions in cancer patients were made during off-hours, and 22.3% of the patients initially considered “too well to benefit” from ICU admission were subsequently admitted to the ICU. Both decisions during off-hours and a delayed ICU admission were associated with an increased risk of death at 30 days. Our study suggests that in cancer patients, ICU triage decisions should be discussed during on-hours, and ICU admission policy should be broadened, with a lower admission threshold for critically ill cancer patients.
dc.format.extent13 páginas
dc.fuente.origenAutoarchivo
dc.identifier.citationAnnals of Intensive Care. 2021 Aug 11;11(1):125
dc.identifier.doi10.1186/s13613-021-00898-2
dc.identifier.urihttps://doi.org/10.1186/s13613-021-00898-2
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/61942
dc.identifier.wosidWOS:000684211900001
dc.information.autorucEscuela de Medicina ; Bakker, Jan ; 0000-0003-2236-7391 ; 1044227
dc.issue.numeroNo. 125
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final13
dc.pagina.inicio1
dc.revistaAnnals of Intensive Carees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectIntensive care unites_ES
dc.subjectCritical carees_ES
dc.subjectTriagees_ES
dc.subjectAdmission decisionses_ES
dc.subjectMalignancyes_ES
dc.subjectCanceres_ES
dc.subjectMortalityes_ES
dc.subject.ddc616.028
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleOutcome of cancer patients considered for intensive care unit admission in two university hospitals in the Netherlands: the danger of delayed ICU admissions and off-hour triage decisionses_ES
dc.typeartículo
dc.volumenVol. 11
sipa.codpersvinculados1044227
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