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  • Title: Association between strained capacity and mortality among patients admitted to intensive care: A path-analysis modeling strategy.
    Author: Bagshaw SM, Wang X, Zygun DA, Zuege D, Dodek P, Garland A, Scales DC, Berthiaume L, Faris P, Chen G, Opgenorth D, Stelfox HT.
    Journal: J Crit Care; 2018 Feb; 43():81-87. PubMed ID: 28854400.
    Abstract:
    PURPOSE: To evaluate the associations between strained ICU capacity and patient outcomes. METHODS: Multi-center population-based cohort study of nine integrated ICUs in Alberta, Canada. Path-analysis modeling was adopted to investigate direct and indirect associations between strain (available beds ≤1; occupancy ≥95%) and outcomes. Mixed-effects multivariate regression was used to measure the association between strain and acuity (APACHE II score), and both acuity and strain measures on ICU mortality and length of stay. RESULTS: 12,265 admissions comprise the study cohort. Available beds ≤1 and occupancy ≥95% occurred for 22.3% and 17.0% of admissions. Lower bed availability was associated with higher APACHE II score (p<0.0001). The direct effect of ≤1 available beds at ICU admission on ICU mortality was 11.6% (OR 1.116; 95% CI, 0.995-1.252). Integrating direct and indirect effects resulted in a 16.5% increased risk of ICU mortality (OR 1.165; 95% CI, 1.036-1.310), which exceeded the direct effect by 4.9%. Findings were similar with strain defined as occupancy ≥95%. Strain was associated with shorter ICU stay, primarily mediated by greater acuity. CONCLUSIONS: Strained capacity was associated with increased ICU mortality, partly mediated through greater illness acuity. Future work should consider both the direct and indirect relationships of strain on outcomes.
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