View
Publication Type
Journal Article
Author, Analytic
Augier, R. ; Hambleton, Ian R.; Harding, Hyacinth E.
Author Affiliation, Ana.
Tropical Medicine Research Institute; Department of Surgery, Radiology, Anaesthesia and Intensive Care
Article Title
Triage decisions and outcome among the critically ill at the University Hospital of the West Indies
Medium Designator
n/a
Connective Phrase
n/a
Journal Title
West Indian Medical Journal
Translated Title
n/a
Reprint Status
n/a
Date of Publication
2005
Volume ID
54
Issue ID
3
Page(s)
181-186
Language
English
Connective Phrase
n/a
Location/URL
http:; caribbean.scielo.org/pdf/wimj/v54n3/v54n3a05.pdf
ISSN
0043-3144
Notes
n/a
Abstract
The worldwide scarcity of intensive care therapy leads to the rationing of this expensive resource. This prospective study investigates the rationing of intensive therapy at the University Hospital of the West Indies (UHWI) by recording triage decisions for intensive care unit (ICU) admission and the impact of these decisions on patient outcome. Between June 2001 and May 2002, all patients triaged for admission to a multidisciplinary ICU were studied For each patient, data were collected including APACHE II score, ICU resource availability and patient survival. There were 356 eligible requests, and 285 (80%) were admitted to the ICU, with 73 (26%) of these admitted patients receiving intensive care outside of the ICU due to space limitations. The APACHE II score was the strongest predictor of ICU admission, with admission more likely as the score decreased (odds ratio = 0.94, 95% confidence interval 0.91, 0.98, p = 0.001). Of 311 requests considered suitable for admission, 26 (8%) were refused admission due to resource limitations. Mortality among these eligible refusals was 81%, compared to 34% among admitted patients (p < 0.001). Although triage decisions are based predominantly on a patient's disease severity, the demand for ICU space exceeds supply, and patient care is negatively impacted by this imbalance.....
read more