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Impact of age, physiological status and APACHE score on acceptance of patients to the ICU

Introduction

Evidence suggests that age, chronic health status and acute illness severity affect the decision-making of clinicians regarding admission to the ICU (ITU) [13]. This prospective service review assesses the impact of age, APACHE II score and WHO functional score towards admission acceptance or refusal to ITU in a tertiary-level facility.

Methods

Design: a planned prospective review of all referrals over a 14-day period. Data collection: review (LT, DP, SP) of case notes of patients referred to ITU with the following variables collected: age, sex, APACHE II scores, WHO functional status score, grade of referrer and source of referral. Data were collected on 37 patients: 22 accepted to ITU and 15 refused admission. Statistics: data were analyzed using GraphPad 6.05. Categorical variables were expressed as mean and standard error of mean. For unpaired variables, statistical significance is determined using unpaired t test. P < 0.05 is considered statistically significant.

Results

The WHO functional status was the most significant variable affecting admission (P < 0.001). The APACHE score of patients admitted to ITU was significantly lower than refused patients (P = 0.039). Patient age did not affect admission status (P = 0.15). See Table 1.

Table 1

Conclusion

This study was performed to assess decision-making for admission to the ITU in times of increased demand and limited availability. We want to validate our findings from this short pilot study in a larger prospective study. Multivariate regression analysis will be used to identify significant features that affect clinician decision making in critical care admission.

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Terry, L., Passey, S., Porter, D. et al. Impact of age, physiological status and APACHE score on acceptance of patients to the ICU. Crit Care 19, P522 (2015). https://doi.org/10.1186/cc14602

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Keywords

  • Functional Status
  • Multivariate Regression Analysis
  • Status Score
  • Acute Illness
  • Case Note