The Value of Intensive Care in Patients without Organ Failure

The CLAHRC WM Director has been of the opinion that Intensive Care is overused and wastes resources when patients without organ failure are treated in the ICU, rather than a medical ward. Well it looks like he might have been wrong about that, at least according to a recent article and accompanying editorial in JAMA.[1] [2] The authors compared differences in death rates for pneumonia without organ failure according to whether the local referral hospital had, or did not have, an ICU. Access to ICU was regarded as an Instrumental Variable on the assumption that this is not associated with the outcome of care, net of (any) effect of the ICU itself. By Jupiter, there was a big improvement in 30 day mortality (over five percentage points) in the Instrumental Variable analysis. Why was this? Perhaps better diagnosis resulting from high-intensity specialist medical care? The CLAHRC WM associated HiSLAC (High-intensity Specalist-Led Acute Care) study has been designed to shed light on this hypothesis.

— Richard Lilford, CLAHRC WM Director

References:

  1. Valley TS, Sjoding MW, Ryan AM, Iwashyna TJ, Cooke CR. Association of Intensive Care Unit Admission with Mortality Among Older Patients with Pneumonia. JAMA. 2015; 314(12): 1272-9.
  2. Barbash IJ & Kahn JM. Assessing the Value of Intensive Care. JAMA. 2015; 314(12):1240-1.
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