ICU sedation, delirium & recovery
Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department*
Authors' conclusion
The implementation of a novel ECCP was associated with a significant decrease in inhospital mortality among critically ill medical ED patients, with the greatest decrease observed in patients with intermediate severity of illness.
Study context
- Population
- Adult medical emergency department (ED) patients with a critical care admission order within 12 hours of arrival, tertiary academic medical centerprimary cohort
- Participants
- 2,250 patients
- Exposure
- Emergency Critical Care Program (ECCP) hours vs non-ECCP hours, preintervention vs intervention period
- Outcome
- In-hospital mortality and ED downgrade to non-ICU status within 6 hours of the critical care admission order (ED downgrade <6 hr)
Methodological detailssingle-centre, difference-in-differences analysis, emergency critical care Sequential Organ Failure Assessment (eccSOFA)-adjusted
- Single-centre
- Difference-in-differences analysis
- eccSOFA-adjusted
Main finding
As reported in the abstract
Difference-in-differences (DiD) for eccSOFA-adjusted in-hospital mortality: decreased by
6.0%
95% CI −11.9 to −0.1
DiD for ED downgrade <6 hr: increase not statistically significant
4.8%
DiD, 4.8%; 95% CI, −0.7 to 10.3%
Observational data: associations, not effects.
Further findings
In-hospital mortality, intermediate illness severity (subgroup)
- Largest difference in intermediate illness severity group
- −12.2% (DiD, −12.2%; 95% CI, −23.1 to −1.3)
- Difference-in-differences
ED downgrade <6 hr, intermediate illness severity (subgroup)
- Significant increase in intermediate group
- 8.8% (DiD, 8.8%; 95% CI, 0.2-17.4)
- Difference-in-differences
Original publication
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