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Epidemiology of Intensive Care

Published online by Cambridge University Press:  14 October 2009

Lis Dragsted  and
Jesper Qvist
Lis Dragsted
Affiliation:
University of Copenhagen
Jesper Qvist
Affiliation:
University of Copenhagen
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Abstract

It is difficult to study the epidemiology of ICUs, as they lack a uniform nomenclature and/or classification. The organization and distribution of intensive care medicine depend on the size and function of the hospital. The patients in ICUs are predominantly men, with a high proportion of elderly patients (≥70 years) constituting 25–30% of the total. Case-mix, severity of illness and outcome differ from one unit to another, and can be compared only if the patients are classified with a common classification system. Most survivors of intensive care seem to return to normal or near normal functional level within one year. Compared to Western Europe, the United States has more ICU beds and a nearly ten times higher admission rate to intensive care. These variations can be seen as a result of a fundamental difference in the attitudes toward withdrawing or withholding life support.

Type
Special Section: Intensive Care: Where Are We?
Information
International Journal of Technology Assessment in Health Care , Volume 8 , Issue 3 , Summer 1992 , pp. 395 - 407
Copyright
Copyright © Cambridge University Press 1992

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References

REFERENCES

1.Aaron, H. J., & Schwartz, W. B.The painful prescription: Rationing hospital care. Washington, DC: The Brookings Institutions, 1984.Google Scholar
2.Berenson, R. A.Intensive care units (ICUs). Clinical outcomes, costs, and decisionmaking (Health Care Technology Case study 28) prepared for the Office of Technology Assessment, US Congress. OTA–HCS–28, Washington, DC, 1984.Google Scholar
3.Bergner, M., Bobbitt, R. A., Carter, W. B., & Gilson, B. S.The sickness impact profile: Development and final revision of a health status measure. Medical Care, 1981, 19, 787–805.CrossRefGoogle ScholarPubMed
4.Byrick, R. J., Mindorff, R. M., McKee, L., & Mudge, R. M.Cost–effectiveness of intense care for respiratory failure patients. Critical Care Medicine, 1980, 8, 332–37.CrossRefGoogle Scholar
5.Campion, E. W., Mulley, A. G., Goldstein, R. L., et al. Medical intensive care for the elderly. A study of current use, costs, and outcomes. Journal of the American Medical Association, 1981, 246, 2052–56.CrossRefGoogle ScholarPubMed
6.Chang, R. W. S., Jacobs, S., & Lee, B.Predicting outcome among intensive care unit patients using computerized analysis of daily APACHE II scores corrected for organ system failure. Intensive Care Medicine, 1988, 14, 558–66.CrossRefGoogle ScholarPubMed
7.Chang, R. W. S.Individual prediction models for intensive care units. Lancet, 1989, ii, 143–46.CrossRefGoogle Scholar
8.Chassin, M. R.Costs and outcome of medical intensive care. Medical Care, 1982, 20, 165–79.CrossRefGoogle ScholarPubMed
9.Civetta, J. M.The inverse relationship between cost and survival. Journal of Surgical Research, 1973, 14, 265–69.CrossRefGoogle ScholarPubMed
10.Cullen, D. J., Ferrara, L. C., Briggs, B. A., et al. Survival, hospitalization charges, and follow up results in critically ill patients. New England Journal of Medicine. 1976, 294, 982–87.CrossRefGoogle ScholarPubMed
11.Cullen, D. J., Keene, R. A., Waternaux, C., et al. Severity of illness, outcome analysis, and cost of intensive care for critically ill patients. In Parillo, J. E. & Ayres, S. M. (eds.), Major issues in critical care medicine. Baltimore, MD: Williams & Wilkins, 1984, 47–59.Google Scholar
12.Dragsted, L., & Qvist, J.Outcome from intensive care I: A five year study of 1308 patients. Methodology and patient population. European Journal of Anaesthesia, 1989, 6, 23–37.Google Scholar
13.Dragsted, L., Jorgensen, J. C., Jensen, N. H., et al. Interhospital comparisons of patient outcome from intensive care: The importance of leadtime bias. Critical Care Medicine, 1989, 12, 418–22.CrossRefGoogle Scholar
14.Dragsted, L., & Qvist, J.Outcome from Intensive Care III: A five year study of 1308 patients’ activity level. European Journal of Anaesthesia, 1989, 6, 385–96.Google Scholar
15.Dragsted, L., Qvist, J., & Madsen, M.Outcome from intensive care IV: A five year study of 1308 patients. Long term outcome. European Journal of Anaesthesia, 1990, 7, 51–62.Google Scholar
16.Dragsted, L., Ryding, J., Qvist, J., et al. The costs of critical care therapy (abstr.) Intensive Care Medicine, 1990 (suppl. 1) 37.Google Scholar
17.Draper, E. A., Wagner, D. P., & Knaus, W. A.The use of intensive care: A comparison of a university and community hospital. Health Care Finances Review, 1981, 3, 49–65.Google ScholarPubMed
18.Fedullo, A. J., & Swinburne, A. J.Relationship of patient age to cost and survival in a medical ICU. Critical Care Medicine, 1983, 11, 155–59.CrossRefGoogle Scholar
19.Grenvik, A. The ICU in the modern hospital. In Miranda, D. R. & Langrehr, D. (eds.), The ICU–a cost benefit analysis. Amsterdam: Excerpta Medica, 1986, 27–37.Google Scholar
20.Kassirer, J. P., & Pauker, S. G.The toss–up. New England Journal of Medicine, 1981, 305, 1467–69.CrossRefGoogle ScholarPubMed
21.Knaus, W. A., LeGall, J. R., Draper, E. A., et al. A comparison of intensive care in the USA and France. Lancet, 1982, ii, 642–46.CrossRefGoogle Scholar
22.Knaus, W. A., Draper, E. A., Wagner, P., & Zimmerman, J. E.APACHE II: A severity of disease classification system. Critical Care Medicine, 1985, 13, 818–23.CrossRefGoogle ScholarPubMed
23.Laufman, H. Planning and building the ICU: Problems of design, infection control and cost–benefit. In Miranda, D. R. & Langrehr, D. (eds.), The ICU–a cost–benefit analysis. Amsterdam: Excerpta Medica, 1986, 65–79.Google Scholar
24.LeGall, J. R., Brun-Buisson, C., Trenet, P., et al. Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Critical Care Medicine, 1982, 10, 575–77.Google Scholar
25.LeGall, J. R., Loirat, P., Alperovitch, A., et al. A simplified acute physiology score for ICU patients. Critical Care Medicine, 1984, 12, 957–77.Google Scholar
26.LeGall, J. R., Loirat, P., Mathieu, D., Williams, A. The patients in management of intensive care. In Miranda, D. R., Williams, A., & Loirat, P. (eds.), Guidelines for better use of resources. Dordrecht: Kluwer Academic Publishers, 1990.Google Scholar
27.Loes, O., Smith-Erichsen, N., & Lind, B.Intensive care, cost and benefit. Acta Anaesthesiologica Scandinavica, 1987, 31 (suppl. 84) 3–19.CrossRefGoogle Scholar
28.Miranda, D. R. ICUs in Europe. In Miranda, D. R., & Langrehr, D. (eds.), The ICU–a cost-benefit analysis. Amsterdam: Excerpta Medica, 1986, 207–19.Google Scholar
29.Morgan, A., Daly, C., & Murawski, B. J.Dollars and the human costs of intensive care. Journal of Surgical Research, 1973, 14, 441–48.CrossRefGoogle ScholarPubMed
30.Parno, J. R., Teres, D., & Lemeshow, S.Hospital charges, and longterm survival of ICU versus non ICU patients. Critical Care Medicine, 1982, 10, 569.CrossRefGoogle ScholarPubMed
31.Parno, J. R., Teres, D., Lemeshow, S., et al. Two year outcome of adult intensive care patients. Medical Care, 1984, 22, 167–76.CrossRefGoogle ScholarPubMed
32.Patrick, D. J., Danis, M., Southerland, L. I., & Hong, G.Quality of life following intensive care. Journal of General Internal Medicine, 1988, 3, 218–23.CrossRefGoogle ScholarPubMed
33.Relman, A. S.Intensive care units, who needs them? New England Journal of Medicine, 1980, 302, 965–66.CrossRefGoogle Scholar
34.Relman, A. S.Assessment and accountability. The third revolution in medical care. New England Journal of Medicine, 1988, 319, 1220–22.CrossRefGoogle ScholarPubMed
35.Ruark, J. E., & Raffin, T. A.Initiating and withdrawing life support. Principles and practice in adult medicine. New England Journal of Medicine, 1988, 318, 25–33.CrossRefGoogle ScholarPubMed
36.Sage, V. M., Rosenthal, M. H., & Silverman, J. F.Is intensive care worth it? An assessment of input and outcome for the critically ill. Critical Care Medicine, 1986, 14, 777–82.CrossRefGoogle ScholarPubMed
37.Scheffler, R. M., Knaus, W. A., Wagner, D. P., & Zimmerman, J. E.Severity of illness in the relationship between intensive care and survival. American Journal of Public Health, 1982, 72, 449–52.CrossRefGoogle ScholarPubMed
38.Spitzer, W. O., Dobson, A. J., & Hall, J.Measuring the quality of life of cancer patients. A concise QL-index for use by physicians. Journal of Chronic Diseases, 1981, 34, 585–97.CrossRefGoogle ScholarPubMed
39.Thibault, G. E. The medical intensive care unit: A five year perspective. In Parillo, J. E., & Ayres, S. M. (eds.), Major issues in critical care medicine. Baltimore, MD: Williams & Wilkins, 1984.Google Scholar
40.Vincent, J. L.European attitudes towards ethical problems in intensive care medicine: Results of an ethical questionnaire. Intensive Care Medicine, 1990, 16, 256–64.CrossRefGoogle ScholarPubMed
41.Zaren, B.Prognosis of outcome from intensive care patients (Thesis). Acta Universitatis Upsaliensis, 1987.Google Scholar
42.Zimmerman, J. E. Administrative structure of a critical care unit. In Parillo, J. E., & Ayres, S. M. (eds.), Major issues in critical care medicine. Baltimore, MD: Williams & Wilkins, 1984.Google Scholar
43.Zimmerman, J. E.APACHE III study design: Analytic plan for evaluation of severity and outcome. Critical Care Medicine, 1989, 17(suppl.), S169–S221.Google Scholar