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Hospital mortality associated with day and time of admission to intensive care units

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Abstract

Objective

To investigate whether hospital mortality of patients was associated with the day of the week or time of admission to intensive care units (ICUs).

Design

Cohort study.

Setting

One hundred two adult, general (mixed medical/surgical) ICUs in England, Wales and Northern Ireland.

Patients and participants

A total of 56,250 admissions from 1995 to 2000 that fit the inclusion criteria for calculation of the APACHE II probability of hospital mortality.

Interventions

None.

Measurements and results

Crude and case mix adjusted hospital mortality were examined by day of the week and time of day of admission to ICU. Patients admitted on Saturday and Sunday had higher crude hospital mortality compared with admissions on Wednesday [Saturday crude odds ratio (OR) 1.41, 95% CI 1.32–1.52; Sunday OR 1.56, 1.45–1.68]. The association was still significant after adjustment using the UK APACHE II model (Saturday OR 1.16, 1.1.07–1.26; Sunday OR 1.24, 1.14–1.35) but not after adjustment using individual components of the APACHE II model (Saturday OR 1.03, 0.95–1.12; Sunday OR 1.09, 1.00–1.19). Night admissions were also associated with higher mortality compared with day both before and after adjustment for case mix using the UK APACHE II model (crude OR 1.43, 1.37–1.51; adjusted OR 1.16, 1.10–1.23) but not after adjustment using components of the APACHE II model (OR 1.02, 95% CI 0.96–1.09).

Conclusions

After appropriate adjustment for case mix, day of the week and time of day of admission of patients to ICU were not associated with significant differences in hospital mortality.

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Acknowledgements

We thank everyone in the ICUs participating in the Case Mix Programme and those responsible for local funding. We are grateful to A. Padkin for his advice on the study design, to D. Altmann for his assistance with the statistics and to the two anonymous reviewers who helped improve this article.

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Authors and Affiliations

  1. Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

    Hannah Wunsch & James Mapstone

  2. Intensive Care National Audit & Research Centre (ICNARC), Tavistock House, Tavistock Square, London, WC1H 9HR, UK

    Tony Brady, Rosa Hanks & Kathryn Rowan

Authors
  1. Hannah Wunsch
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  2. James Mapstone
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  3. Tony Brady
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  4. Rosa Hanks
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  5. Kathryn Rowan
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Corresponding author

Correspondence to Kathryn Rowan.

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Wunsch, H., Mapstone, J., Brady, T. et al. Hospital mortality associated with day and time of admission to intensive care units. Intensive Care Med 30, 895–901 (2004). https://doi.org/10.1007/s00134-004-2170-3

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  • DOI: https://doi.org/10.1007/s00134-004-2170-3

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