Chest
ORIGINAL RESEARCHCRITICAL CARE MEDICINEAssociation Between Time of Admission to the ICU and Mortality: A Systematic Review and Metaanalysis
Section snippets
Search Strategy
Two investigators independently searched the Medline and Embase databases through September 2009 using a combination of terms that included “critical care,” “time,” and “admission,” with no restriction to date or language. We also reviewed the bibliographies of all selected articles for other potential relevant articles.
Study Selection
Although the definition of “off-hours” differed among the studies, we use the term “off-hours” to refer to either nighttime or weekend admissions. Thus, studies were eligible to
Results
The Medline and Embase searches retrieved 796 and 173 citations, respectively. After screening the titles and abstracts from these citations and the bibliographic references from relevant articles, we selected 21 studies for full review.5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 Although our initial search was not restricted to any specific language, only English-language articles were included in the final analysis.22 Although Arabi et al20 evaluated weekend or
Discussion
The main finding of this metaanalysis is that patients admitted to an ICU over the weekend have an 8% higher risk of death, after adjusting for severity of illness, as compared with patients admitted during weekdays. Accounting for sampling variability, this increased risk could be as low as 4% or as high as 13%. This finding should, however, be viewed with caution because the metaanalysis was dominated by one study.5 Furthermore, the control group in that study included admissions only during
Acknowledgments
Author contributions: Dr Cavallazzi: contributed to the literature search, data extraction, statistics, and writing of the manuscript.
Dr Marik: contributed to the study concept and design, and writing and final editing of the manuscript.
Dr Hirani: contributed to the literature search, data extraction, and review of the manuscript.
Dr Pachinburavan: contributed to the data review and review of the manuscript.
Dr Vasu: contributed to the data review and review of the manuscript.
Dr Leiby:
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